Study Examines Medication Risks for Veterans of Child-bearing Age
BACKGROUND:
Among women Veterans using VA healthcare, 43% are between the ages of 18-44 years (reproductive age). While some medications are contraindicated during pregnancy, others have suspected or unknown risk. For example, antidepressants in the selective serotonin reuptake inhibitor (SSRI) or serotonin norepinephrine reuptake inhibitor (SNRI) class, used to treat depression, anxiety, and PTSD, have been associated with various adverse outcomes (i.e., low birth weight), but their risks are outweighed by important benefits to Veterans with mental illness. This study investigated medication use and the role of comorbidity among pregnant Veterans receiving VA care – and where patient education or provider-to-provider communication is needed. Investigators recruited 501 pregnant women from 2016 to 2019 (63% had 50-100% service-connected disability). Medical record data were summarized for three 9-month periods: the 280 days prior to estimated conception date, the 280 days of pregnancy from conception to due date/date of birth, and the first 280 days after due date/date of birth. Veterans were included in this study if they used VA care during all three periods.
FINDINGS:
- Based on prescriptions filled within VA only, women Veterans were prescribed numerous medications during pregnancy and discontinued antidepressants at a substantial rate.
- The median number of drug classes prescribed during pregnancy was five. Use of SSRI/SNRI antidepressants dropped from 36% preconception to 26% during pregnancy, including new starts, and 15% of pregnant Veterans discontinued SSRI/SNRI treatment.
- Comorbidity predicted medication use.
- Predictors of discontinuing SSRI/SNRI antidepressants during pregnancy were examined, and only Black race was identified as a predictor.
IMPLICATIONS:
- Veterans of childbearing age should receive counseling about medication use before pregnancy. Their non-VA obstetricians and VA providers should share information to optimize outcomes.
LIMITATIONS:
- Medications prescribed and care received outside VA were unknown; some substitution of medications may have occurred, or new classes of drugs could have been obtained.
AUTHOR/FUNDING INFORMATION:
This study was funded by HSR&D. Drs. Copeland, Kinney, Kroll-Desrosiers, and Mattocks are with VA Central Western Massachusetts Healthcare System; Dr. Shivakumar is with VA North Texas health care.
Copeland L, Kinney R, Kroll-Desrosiers A, Shivakumar G, and Mattocks K. Medications with Potential for Fetal Risk Prescribed to Veterans. Journal of Women’s Health. March 23, 2022; online ahead of print.
