SSRIs in women of reproductive age; a systematic review of local formularies

Background Depression is the second most common chronic condition affecting women of reproductive age; 23.4% of women enter pregnancy with depression and use of Selective Serotonin Reuptake Inhibitors (SSRIs) in pregnancy is often necessary for maternal wellbeing. However, SSRI use during pregnancy can cause congenital malformations, post-partum haemorrhage (PPH) and Persistent Pulmonary Hypertension of the newborn (PPHN). In UK primary care, prescribing formularies are one medium by which prescribers are provided with local medicines advice.

Aim To review all local prescribing formularies with respect to prescribing SSRIs in women of reproductive age, during pregnancy and during breastfeeding.

Design & setting Prescribing formularies in England and Wales.

Method A systematic keyword search of all Clinical Commissioning Group (CCG) and Integrated Care Board (ICB) websites in England and Local Health Board (LHB) websites in Wales was undertaken between December 2021–22 to identify prescribing formularies. Data were extracted on prescribing guidance for SSRIs.

Results 74 prescribing formularies were reviewed. 14.9% (11/74) provided links to the Medicines and Healthcare Regulatory products Agency guidance on congenital abnormalities associated with SSRIs, 28.4% (21/74) to guidance on PPH risk and 1.4% (1/74) to guidance on PPHN. Specific local guidance was given on SSRI prescribing for women of reproductive age, during pregnancy and during breastfeeding in 12.2% (9/74), 23% (17/74) and 21.6% (16/74) of formularies respectively.

Conclusion Our results suggest that prescribers may be poorly informed by local formularies about the risks of SSRI use around pregnancy. This may place babies at increased risk of unintentional SSRI exposure.