Selective serotonin reuptake inhibitors (SSRIs) in women of reproductive age: a systematic review of local formularies

Elizabeth Lovegrove; Alice Maidwell-Smith; Beth Stuart; Miriam Santer

doi:10.3399/BJGPO.2023.0255

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Figure 1. Flow chart of Integrated Care Boards in England and Local Health Boards in Wales and associated available prescribing formularies.
CCG = clinical commissioning group. ICB = Integrated Care Board. LHB = Local Health Board.
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Figure 2. Percentage of formularies that provided locally generated guidance only, external guidance only, both locally generated and external guidance, or no guidance; for women of reproductive age, during pregnancy and during breastfeeding (n = 73 formularies).
SSRI = selective serotonin reuptake inhibitor.
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Figure 3. Percentage of formularies that included a hyperlink to, or a description of the contents of, specific MHRA alerts regarding SSRI use (n = 73 formularies).
MHRA = Medicines and Healthcare products Regulatory Agency. PPH = postpartum haemorrhage. PPHN = persistent pulmonary hypertension in the newborn. SSRI = selective serotonin reuptake inhibitor.

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Table 1. Data points extracted for all formularies included in the review

Topic area	Detail of data extracted
ICB/LHB name	The name and location of the ICB/LHB (eg, NHS Dorset ICB)
Formulary location	The URL of the formulary was recorded and the method by which the formulary was located (via ICB/LHB website or keyword web search)
Date of extraction	The date the data were extracted from the formulary
Formulary version	The last date the formulary was updated
Formulary structure	How the formulary was structured; that is, by body system (eg, central nervous system), by medication class (eg, SSRI or antidepressant), or by individual medication name (eg, sertraline)

ICB = Integrated Care Board. LHB = Local Health Board. SSRI = selective serotonin reuptake inhibitor. URL = uniform resource locator.

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Table 2. Data points extracted from formularies containing locally generated guidance regarding SSRI prescribing in women of reproductive age, during pregnancy, or during breastfeeding

		Data points extracted for each patient group
Patient group	Women of reproductive age	Advice regarding first and second line SSRIs to be used in this group Advice regarding contraindicated SSRIs in this group Advice regarding counselling that HCPs should provide to this group regarding SSRIs Advice regarding contraception in this group in relation to SSRIs Advice regarding congenital abnormalities in this group in relation to SSRIs
	Pregnant women	Advice regarding first and second line SSRIs to be used in this group Advice regarding contraindicated SSRIs in this group Advice regarding counselling that HCPs should provide to this group regarding SSRIs
	Breastfeeding women	Advice regarding first and second line SSRIs to be used in this group Advice regarding contraindicated SSRIs in this group Advice regarding counselling that HCPs should provide to this group regarding SSRIs
	All (women of reproductive age AND pregnant women AND breastfeeding women)	Advice regarding contraception in relation to SSRIs Advice regarding congenital abnormalities in relation to SSRIs Advice regarding when to refer to specialist perinatal mental health Advice regarding risk PPHN with SSRI use Advice regarding neonatal withdrawal with SSRI use Advice regarding PPH risk with SSRI use

HCP = healthcare professional. PPH = postpartum haemorrhage. PPHN = persistent pulmonary hypertension of the newborn. SSRI = selective serotonin reuptake inhibitor.

Supplementary Data

EL_10.3399BJGPO.2023.0255_supp.pdf -
Supplementary material is not copyedited or typeset, and is published as supplied by the author(s). The author(s) retain(s) responsibility for its accuracy.