Adherence And Persistence To Antidepressant Medication During Pregnancy: Does It Differ By The Class Of Antidepressant Medication Prescribed?

Introduction Pregnant women are often concerned about the impact of antidepressant medication use on their pregnancy, such as congenital abnormalities. This concern may vary in a way that depends on the class of antidepressant medication prescribed. Objectives and Approach This study examined the rate of adherence and persistence to antidepressants based on the class of antidepressants prescribed during pregnancy This is a retrospective cohort study using population-based administrative data in Alberta– linking delivery record, hospitalization data, physician claims data, emergency department data, and prescription medication data. The eligible study population included women with depression who gave birth between 2012-2015, and were adherent (medication possession ratio ≥80%) to ≥ 2 consecutive antidepressant prescriptions during the preconception year (n=1,865). The rates of adherence and persistence (prescription refill gap ≤30 days) were calculated by medication class and were compared using chi-square tests. Results During pregnancy, 834 (44.7%) women completely stopped taking antidepressants. Among those taking antidepressants, the overall rate of adherence was 62.6% (95% CI: 59.4%, 65.7%). The rate differed significantly by medication class (p<0.0001), with rate of 75.1% (95% CI: 68.3%, 80.9%) for serotonin-norepinephrine inhibitors, 60.9% (95% CI: 57.2%, 64.5%) for selective serotonin reuptake inhibitors, 42.9% (95% CI: 19.9%, 69.2%) for non-selective monoamine reuptake inhibitors, and 37.5% (95% CI: 22.4%, 55.4%) for the atypical antidepressants. Similarly, 40.7%, (95% CI: 37.5, 44.0) of women were persistent to antidepressants up to the full pregnancy period – similar to the adherence pattern, the rate differed significantly by medication class. Conclusion/Implications Adherence to and persistence in using antidepressants is low during pregnancy and it varies by medication class, possessing to the worsening of depression symptoms. This could be improved by conducting more research on drug safety during pregnancy and translating research evidence into treatment decision and correcting mothers’ misperceptions towards antidepressants

The Effect of Medication Adherence on the Disease Course in Pregnant Women with Inflammatory Bowel Disease

Introduction Medical therapy to maintain disease remission is important in pregnant women with inflammatory bowel disease (IBD), as disease flares can predispose adverse materno-fetal outcomes. However, women with IBD are more concerned about medication exposure on their newborn during pregnancy, and often discontinue their medications. Objectives and Approach We assessed the rate of disease flare on medication adherence pattern during pregnancy for women with IBD. Validated case definition was used to identify women with IBD from the Albertan’s hospitalization, emergency room, and physician claims databases (2010-2016). Pharmaceutical Information Network provided the dispensed medications. Adherence to medication was defined by medical possession ratio (MPR)≥0.8. Women with two consecutive prescriptions and MPR≥0.8 during pre-conception were included. Disease flare was defined by ≥1 hospitalization or emergency visit for IBD, or ≥1 prescription for steroids/rectal therapy. Chi-square tests and log binomial regression were used; covariates included age, drug class, and IBD subtypes. Results Of the 370 women identified with IBD, 170 (45.9%) women were adherent to maintenance IBD medications in the one year prior to pregnancy. During pregnancy, 47 (27.6%; 95% CI: 21.4% to 34.9%) women, who demonstrated adherence in the pre-conception period, discontinued or were not adherent to their IBD medications, and 67 (39.4%; 95% CI: 32.3% to 47.0%) women had a disease flare during pregnancy. There was no significant difference between adherence to medication during pregnancy and a disease flare during pregnancy (p=0.38). In comparing women who were not adherent or discontinued their medication to those that were adherent, the adjusted relative risk ratio for a disease flare during pregnancy was 1.22 (95% CI: 0.81 to 2.04). Conclusion/Implications The rate of disease flare during pregnancy was not significantly different for women with IBD that were adherent or not-adherent to their IBD medications during pregnancy. Future analysis will assess the rate of disease flare on medication adherence pattern prior to pregnancy

Development and validation of data quality rules in administrative health data using association rule mining

Introduction Data quality assessment is a challenging facet for researches using coded administrative health data. Our previous study had demonstrated the potentials of association rule mining to assess data quality. The objective of this study is to develop and validate a set of coding association rules for data quality assessment. Objectives and Approach We used the Canadian reabstracted hospital discharge abstract data (DAD) with clinical diagnosis coded in International Classification of Disease – 10th revision, Canada (ICD-10-CA) codes for rule development. The DAD data were divided into 5 age groups. Association rule mining were conducted on reabstracted DAD in each age group to extract ICD-10 coding association rules at the three and four digits levels. The rule strength was assessed using support and confidence. The rules will be reviewed by a panel of 5 physicians and 2 coding specialists to assess their appropriateness from clinical and coding perspectives using a modified Delphi rating Results In total, 975 rules at the three digits level and 822 rules at the four digits level were learned from the data. Half of the rules were in the age group of ≥65 and no rules were found in the age group of 5 to 19. The interquartile range of rule confidences were 0.112 to 0.425 in the three digits level and 0.073 to 0.222 in the four digits level. Two-thirds of rules had the diagnosis codes related to endocrine and metabolic disorders and diseases of circulatory, respiratory and genitourinary systems. The panel review will be conducted in early April and will have the final set of rules available before the conference. Conclusion/Implications This study developed a set of validated ICD-10 coding association rules and creates a useful tool to cost-effectively assess data quality in routinely collected administrative health data

Racial/Ethnic Disparity in Association Between Fetal Alcohol Syndrome and Alcohol Intake During Pregnancy: Multisite Retrospective Cohort Study

BackgroundAlcohol consumption during pregnancy is associated with a range of adverse birth-related outcomes, including stillbirth, low birth weight, preterm birth, and fetal alcohol syndrome (FAS). With more than 10% of women consuming alcohol during pregnancy worldwide, it is increasingly important to understand how racial/ethnic variations affect FAS onset. However, whether race and ethnicity inform FAS risk assessment when daily ethanol intake is controlled for remains unknown. ObjectiveThis study aimed to assess racial/ethnic disparities in FAS risk associated with alcohol consumption during pregnancy. MethodsWe used data from a longitudinal cohort study (the Collaborative Initiative on Fetal Alcohol Spectrum Disorders) at 5 hospital sites around the United States of 595 women who consumed alcohol during pregnancy from 2007 to 2017. Questionnaires, in-person interviews, and reviews of medical, legal, and social service records were used to gather data on average alcoholic content (AAC) during pregnancy. Self-reports of maternal race (American Indian/Alaska Native [AI/AN], Asian, Native Hawaiian or other Pacific Islander, Black or African American, White, more than one race, and other) and ethnicity (Hispanic/Latino or not Hispanic/Latino), as well as FAS diagnoses based on standardized dysmorphological criteria, were used for analysis. Log-binomial regression was used to examine the risk of FAS associated with each 1-gram increase in ethanol consumption during pregnancy, stratified by race/ethnicity. ResultsA total of 3.4% (20/595) of women who reported consuming alcohol during pregnancy gave birth to a baby with FAS. Women who gave birth to a baby with FAS had a mean AAC of 32.06 (SD 9.09) grams, which was higher than that of women who did not give birth to a baby with FAS (mean 12.07, SD 15.87 grams). AI/AN mothers with FAS babies had the highest AAC (mean 42.62, SD 8.35 grams), followed by White (mean 30.13, SD 4.88 grams) and Black mothers (mean 27.05, SD 12.78 grams). White (prevalence ratio [PR] 1.10, 95% CI 1.03-1.19), Black (PR 1.13, 95% CI 1.04-1.23), and AI/AN (PR 1.10, 95% CI 1.00-1.21) mothers had 10% to 13% increased odds of giving birth to a baby with FAS given the same exposure to alcohol during pregnancy. Regardless of race, a 1-gram increase in AAC resulted in a 4% increase (PR 1.04, 95% CI 1.02-1.07) in the chance of giving birth to a baby with ≥2 facial anomalies (ie, short palpebral fissures, thin vermilion border of the upper lip, and smooth philtrum) and a 4% increase (PR 1.04, 95% CI 1.01-1.07) in the chance of deficient brain growth. ConclusionsThe risk of delivering a baby with FAS was comparable among White, Black, and AI/AN women at similar levels of drinking during pregnancy. Regardless of race, a 1-gram increase in AAC resulted in increased odds of giving birth to a baby with facial anomalies or deficient brain growth