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2019 HSR&D/QUERI National Conference Abstract

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1030 — Prescription CNS Medication Burden among Pregnant Veterans

Lead/Presenter: Laurel Copeland,  VA Central Western Massachusetts Healthcare System
All Authors: Copeland LA (VA Central Western Massachusetts Healthcare System), Kinney RL (VA Central Western Massachusetts Healthcare System), Kroll-Desrosiers AR (VA Central Western Massachusetts Healthcare System) Mattocks KM (VA Central Western Massachusetts Healthcare System)

Women comprise 15% of the military and 10% of Veterans Affairs (VA) patients. Many psychoactive medications are contraindicated in pregnancy due to evidence of fetal risk or uncertainty regarding whether there is risk. Pregnant women's options include discontinuing a medication, potentially increasing their risk for symptom exacerbation. This study examined correlates of medications prescribed during pregnancy and classified as central nervous system (CNS) active on the VA formulary to investigate medication-related risks unique to pregnant Veterans.

The COMFORT study linked survey and VA medical record data on 460 pregnant veterans using VA healthcare prior to their pregnancies. Pregnant veterans identified at about 20 weeks gestation were enrolled in the COMFORT survey study. Medication fill data were extracted from the Corporate Data Warehouse matching on SSN. Prescription CNS medications filled in the VA system were categorized as antidepressants, opioids, opioid antagonists, benzodiazepines, non-benzodiazepine sedative/hypnotics, antipsychotics, and skeletal muscle relaxants. Correlations assessed the association of medication types with demographics and comorbidity.

Four hundred and sixty women were included in the analysis. Women were predominantly white (67%), married (43%), with service-connected disability (83%). During pregnancy, 30% were diagnosed with a pain-related condition, 19% with depression, and 18% with PTSD; 6% were identified as having TBI/head injury. CNS drugs were the most commonly prescribed class of drugs, accounting for 35% of non-dermatologic 30-day prescriptions, followed by vitamins (11%), hormones and synthetics (10%; includes antidiabetic agents), skeletal muscle relaxants (7%), gastrointestinal medications (6%), antihistamines (6%) and cardiovascular drugs (5%). Being 50-100% service-connected was associated with use of antidepressants, opioids, and antipsychotics. Use of antipsychotics also correlated with alcohol use disorders.

Women veterans receiving prescription medications from the VA during pregnancy are exposed to CNS-active medications at a high rate.

Many medications are contraindicated during pregnancy, e.g., the pain medication duloxetine and several antidepressants. VA outreach to reproductive-aged women veterans and their providers should incorporate awareness of the potential impact of identified mental and behavioral health disorders and their pharmacological treatment on pregnancy and pregnancy outcomes. Postpartum follow-up for change in psychiatric symptoms and re-evaluation of treatment needs may be important.