1. Objectifs

Intentions :
This thesis contains three articles. «[The aim of article 1 is to] explore the characteristics associated with antidepressant discontinuation in pregnancy compared to non-pregnant women taking antidepressants.» (p. 72) «[The aim of article 2 is to] examine the role of depression in influencing preeclampsia risk by assessing risk in untreated depressed women, and in continuers and discontinuers of antidepressant therapy.» (p. 97) «[In article 3, the aim was to] assess the risk of miscarriage in women exposed to antidepressants in early pregnancy, after correcting for induced abortion risk.» (p. 114)

Questions/Hypothèses :
«In this study, we examined a series of questions to address these issues: Are pregnant women more likely to discontinue antidepressant use than are non-pregnant women, i.e. is pregnancy a major determinant of medication discontinuation? What are the maternal characteristics associated with antidepressant discontinuation in pregnancy? Finally, does maternal antidepressant use and discontinuation have consequences on maternal health?» (p. 4)

2. Méthode

Échantillon/Matériau :
Les données proviennent du Régime d’assurance maladie du Québec. Les échantillons retenus sont 53602 (article 1), 29307 (article 2) et 41003 (article 3) femmes ayant accouché au Québec entre 1998 et 2002.

Type de traitement des données :
Analyse statistique

3. Résumé

«[Following the first study, the author concludes that] pregnant women with less severe disease are more likely to discontinue treatment, but because pregnancy itself is a major predictor of discontinuation, physicians need to pay particular attention to pregnant women requiring pre-pregnancy pharmacotherapy to ensure that they receive appropriate guidance on antidepressant use in pregnancy. We found that women who discontinued medication did not have an increased risk of mental health hospitalizations in late pregnancy, and future studies need to determine the risks of untreated and treated depression on pregnancy outcomes.» (p. 72-73) «[Results for the second article show that the] continued use of antidepressants, particularly non-SSRIs [Selective Serotonin Reuptake Inhibitor], in early pregnancy may be associated with an increased risk of preeclampsia, independent of that associated with depression. Pregnant women and their physicians need to carefully consider the various treatment options in pregnancy to optimize maternal and fetal health.» (p. 97) «[Results of the third and last study shows that] Antidepressant use in the first trimester is associated with an increased risk of miscarriage when compared to either non-depressed or depressed unexposed women, even after accounting for induced abortions, although the possibility of residual confounding due to factors related to depression severity cannot be ruled out.» (p. 115)