Utilization of Pregnancy Category D or X Drugs Among Child-Bearing-Age Women with Depression or Bipolar Disorder in Medicaid

BACKGROUND: Many pregnant women with depression or bipolar disorder require medications to minimize the risk of mortality and morbidity. The objective of this study is to evaluate the use of pregnancy category D or X drugs and to quantify the proportion of pregnant women exposed to those drugs among child-bearing age women with depression or bipolar disorder. METHODS: A cohort of 16,385 female patients (in the age range of 15-45 years old) who had at least 12-months enrollment and one bipolar or depression diagnosis were selected for this study. The data source is a multi-state managed care Medicaid claims database (1/1998-12/2002). The proportion of patients taking category D or X drugs and the proportion of those who took category D or X drugs during pregnancy were calculated. Logistic regression was used to identify the factors associated with the risk of taking category D or X drugs during pregnancy. RESULTS: A majority of the 16,385 women with bipolar disorder or depression evaluated (9,658; 58.94%) received either category D or X drugs during the study period. There were 3,108 (18.97%) women with at least one pregnancy during the study period. Of those, 375 (12.07%) o took category D or X drugs during pregnancy. Three-hundred fifty-nine (11.55%) patients took category D drugs and 39 (1.26%) patients took category X drugs during pregnancy. The frequently used category D or X drugs include paroxetine, alprazolam, lorazepam, divalproex sodium, doxycycline hyclate, lithium carbonate, atenolol, temazepam, and medroxyprogesterone acetate. Patients with D or X drugs had significant higher abortion rate (49.9%) compared to women without exposure (28.7%). Women 25-34 years old were more likely to receive D or X drugs (odds ratio: 1.467, 95%CI: 1.149-1.872) compared to women aged 15-24 years. Women aged 35-45 were more likely to receive D or X drugs (odds ratio: 2.356, 95%CI: 1.674-3.315) compared to women aged 15-24 years. Other significant factors associated with the use of these medications included substance abuse (odds ratio: 1.548, 95%CI: 1.076-2.225), anxiety disorder (odds ratio: 1.747, 95%CI: 1.394-2.188), hypertension (odds ratio: 2.183, 95%CI: 1.476-3.230), chronic obstructive pulmonary diseases (odds ratio: 4.984, 95%CI: 2.074-11.979), and arthritis (odds ratio: 3.233, 95%CI: 1.428-7.321).