Angela Lupattelli

University of Oslo · Department of Pharmacy

Importance: Approximately one-half of women treated for affective disorders discontinue antidepressant use during pregnancy, yet this discontinuation could lead to relapse post partum. Objective: To investigate the associations between longitudinal antidepressant fill trajectories during pregnancy and postpartum psychiatric outcomes. Design, se...

The objective of this study was to describe pregnancy-and birth-related experiences of postpartum women during the third wave of the COVID-19 pandemic and their association with mental health outcomes. An online questionnaire was distributed in five European countries (Belgium, The Netherlands, Norway, Switzerland, UK) between June and August 2021....

Objective To describe the mental health of perinatal women in five European countries during the third pandemic wave and identify risk factors related to depressive and anxiety symptoms. Design A cross-sectional, online survey-based study. Setting Belgium, Norway, Switzerland, the Netherlands and the UK, 10 June 2021–22 August 2021. Participants...

Objective: To determine the association between continued antidepressant use in pregnancy and postpartum psychiatric visits for eating (ED) or mood/anxiety disorders in women with preexisting ED. Method: Using Danish health registry data (1998-2015), we identified 3529 pregnancies in women with ED prepregnancy: (i) 564 with continued antidepress...

Background: Few studies investigated longitudinal antidepressant exposure during pregnancy and included dosage in the assessment. Methods: We conducted a nationwide, registry-linkage study in Norway using data on antidepressant prescription fills in pregnancies lasting ≥32 weeks in women with a delivery between 2009 and 2018 who had a depression...

Objectives To investigate the perceived risk of psychotropic and mental illness exposures (1) during pregnancy or (2) while breastfeeding on offspring neurodevelopment, and factors associated with this perception in women with past/current mental illness. Design Cross-sectional, web-based study. Setting Nationwide in Norway, June 2020–June 2021....

This cross-sectional study sought to quantify medication use and change in use of prescription-only medications purchased in the past in Syria without medical prescription versus today in Norway in an adult population originating from Syria and living in western Norway. Data on adults born in Syria and living in Norway during December 2019–January...

(BJOG. 2021;128:1917–1927. [Epub June 8, 2021]) Previous investigations into the risk of offspring developing attention-deficit/hyperactivity disorder (ADHD) due to prenatal exposure to antidepressants have produced inconsistent conclusions. While familial factors have been identified as the most important influence for increased ADHD risk in child...

Importance: Few studies have examined the neurodevelopmental consequences of prenatal exposure to opioid analgesics. Therefore, it is necessary to gain knowledge to inform clinical decisions for pregnant women with moderate to severe pain. Objective: To investigate fifth-grade scholastic skills in children with prenatal exposure to opioid analge...

Background Little is known about mental health care utilization patterns in pregnant women with depression/anxiety in Norway according to antidepressant fill trajectories in pregnancy. Method We conducted a registry-linkage cohort study of pregnancies within women having outpatient visit for depression/anxiety and antidepressant fills prior to pre...

The containment measures following COVID-19 pandemic drastically reduced airway infections, but they also limited the access of patients to healthcare services. We aimed to assess the antibiotic prescription patterns in the Italian paediatric primary care setting before and after the containment measures implementation. For this retrospective analy...

This study examined (1) the availability and content of national CPGs for treatment of peripartum depression, including comorbid anxiety, with antidepressants and other psychotropics across Europe and (2) antidepressant and other psychotropic utilization data as an indicator of prescribers’ compliance to the guidelines. We conducted a search using...

Background Women prescribed antidepressants face the dilemma of whether or not to continue their treatment during pregnancy. Currently, limited evidence is available on the efficacy of continuing versus discontinuing antidepressant treatment during pregnancy to aid their decision. We aimed to estimate whether antidepressant discontinuation before o...

Purpose This study sought to determine the association between gestational diabetes mellitus (GDM) and antidepressant exposure during early-mid pregnancy, overall and according to antidepressant affinity to the histamine-1 (H1) receptor. Methods Data originate from the nation-wide, Norwegian Mother, Father and Child Cohort Study conducted in 1999-...

Objective: To determine the association between child ADHD and prenatal exposure to selective serotonin (SSRI) and serotonin-norepinephrine (SNRI) reuptake inhibitor antidepressants, by timing and duration, with quantification of bias due to exposure misclassification. Design: Norwegian Mother, Father and Child Cohort Study and national health r...

Objectives To assess mental health care utilization patterns during and after pregnancy in women with depression and/or anxiety in Norway according to antidepressant fill trajectories in pregnancy. Method We conducted a registry-linkage cohort study of pregnancies within women having outpatient visit for depression and/or anxiety and antidepressant...

Importance Prior studies have reported that the use of illicit opioids during pregnancy is associated with increased risk of attention-deficit/hyperactivity disorder (ADHD) in offspring; however, evidence regarding the association of analgesic opioids is limited. Objective To examine the association of timing and duration of prenatal analgesic opi...

Current data on use of antihistamines during breastfeeding and risks to the breastfed infant are insufficient. The aim of this systematic review was to provide an overview of studies measuring the levels of antihistamines in human breast milk, estimating the exposure for breastfed infants, and/or reporting possible adverse effects on the breastfed...

Objective To characterize nationwide utilization patterns of migraine pharmacotherapy before, during, and after pregnancy in women with triptan use. Methods Population-based data were obtained by linking the Medical Birth Registry of Norway and the Norwegian Prescription Database from 2006 to 2017. We included 22,940 pregnancies among 19,669 women...

Aims: The aim of the study was two-fold: i) to determine the prevalence of medical care contact for infertility in European countries; ii) to map overall and long-term/chronic medication use during pregnancy in women who sought medical care due to infertility. Methods: This is a sub-study of the Multinational Medication Use in Pregnancy Study, a cr...

Aims: The aim of this study was two-fold: i) to describe factors associated with antithyroid drug (ATD) treatment during gestation among women with hyperthyroidism in pregnancy, ii) to investigate the impact of ATD treatment during gestation on pregnancy outcomes. Methods: Women with hyperthyroidism in pregnancy and ATD treatments were identified t...

Maternal acetaminophen use during pregnancy is associated with increased risk of ADHD in the child. This could reflect causal influence of acetaminophen on fetal neurodevelopment or could be due to confounding factors. The aim of the current study was to examine unmeasured familial confounding factors of this association. We used data from 26,613 c...

In many perinatal pharmacoepidemiologic studies, exposure to a medication is classified as “ever exposed” versus “never exposed” within each trimester or even over the entire pregnancy. This approach is often far from real-world exposure patterns, may lead to exposure misclassification, and fails to incorporate important aspects such as dosage, tim...

Purpose To estimate the association between Attention‐Deficit/Hyperactivity Disorder (ADHD) in children in preschool and primary school, and prenatal exposure to non‐steroidal anti‐inflammatory drugs (NSAIDs) by timing and duration. Methods This study was based on the Norwegian Mother, Father and Child Cohort Study Study linked to the Medical Birt...

This study sought to estimate whether there is a preventative association between antidepressants during pregnancy and postpartum self-harm ideation (SHI), as this knowledge is to date unknown. Using the Multinational Medication Use in Pregnancy Study, we included a sample of mothers who were in the five weeks to one year postpartum period at the t...

Purpose Limited research has focused on the association between thyroid hormone replacement therapy (THRT) and motor function, communication skills, and behaviour in preschool children. Here, we estimated the association between THRT during pregnancy and the first trimester and these developmental outcomes. Methods This study was based on the Norw...

The article Learning the effects of psychotropic drugs during pregnancy using real‑world safety data: a paradigm shift toward modern pharmacovigilance, written by Angela Lupattelli · Olav Spigset · Hedvig Nordeng, was originally published Online First without Open Access.

Nation-wide information about medication use in pregnancy is lacking for Italy, and no study has so far investigated the prescribed medications which pregnant women deliberately avoid. In this study, we map medication use patterns in pregnancy, as well as the extent and type of prescribed medications which are purposely avoided by pregnant women in...

This manuscript extends the definition of the Absolute Standardized Mean Difference (ASMD) for binary exposure (M = 2) to cases for M > 2 on multiple imputed data sets. The Maximal Maximized Standardized Difference (MMSD) and the Maximal Averaged Standardized Difference (MASD) were proposed. For different percentages, missing data were introduced i...

Objectives To assess whether medication beliefs differ between women who use or not use medication for their somatic chronic diseases during pregnancy and whether this association varies across diseases. Design Cross-sectional web-based survey. Setting Multinational study in Europe. Participants Pregnant women or women with children less than 1...

It remains unknown to what degree thyroid hormone replacement therapy (THRT) during and initiation after pregnancy determines pregnancy outcomes. The present study primarily aimed to quantify the impact of THRT patterns (including trajectories) on gestational age, birth weight, and head circumference of infants. The secondary aim was to compare res...

Pharmacoepidemiological studies on the safety of medication during pregnancy are all susceptible to missing data (ie, data that should have been recorded but for some reason were not). Missing data are ubiquitous, irrespective of the data source used. Bias can arise when incomplete data on confounders, outcome measures, pregnancy duration, or even...

Importance Hypothyroidism during pregnancy is associated with neurodevelopmental delays in the offspring. However, it remains unknown whether prenatal thyroid hormone replacement therapy (THRT) has benefits regarding children’s language and communication skills. Objective To quantify associations between prenatal THRT exposure and risk of language...

Background: Recent studies have suggested an association between prenatal paracetamol exposure and adverse neurodevelopmental outcomes in children. However, these findings may be confounded by unmeasured factors related to maternal use of paracetamol and child outcomes. Objective: To examine the association between duration and timing of prenata...

In recent years there has been increased attention to child neurodevelopment in studies on medication safety in pregnancy. Neurodevelopment is a multifactorial outcome that can be assessed by various assessors, using different measures. This has given rise to a debate on the validity of various measures of neurodevelopment. The aim of this review w...

Background Little is known about patients’ Perceived Sensitivity to Medicines (PSM), “the belief that one is especially sensitive to the actions and side effects of medicines”. Objective (i) To explore the extent of and factors associated with high Perceived Sensitivity to Medicines in a Norwegian population of chronic medicine users; (ii) to asses...

Importance The reproductive safety of benzodiazepine/z-hypnotic exposure on child longer-term developmental risks remains unresolved. Objective To quantify the association of motor, communication, and attention-deficit/hyperactivity disorder (ADHD) symptoms in preschoolers with gestational benzodiazepine/z-hypnotic exposure by timing and duration...

Background: During pregnancy women might weigh benefits of treatment against potential risks to the unborn child. However, non-adherence to necessary treatment can adversely affect both mother and child. To optimize pregnant women's beliefs and medication adherence, community pharmacists are ideally positioned to play an important role in primary...

Timeline of questionnaires (MoBa) and of prescription records (NorPD). Notes: MoBa Q1, completed in gestational week 17, covers medication use in early pregnancy. MoBa Q2 is a dietary questionnaire filled out around gestational week 22 and was not included in this study. MoBa Q3, completed in gestational week 30, covers medication use in mid pregna...

Purpose A reliable definition of exposure and knowledge about long-term medication patterns is important for drug safety studies during pregnancy. Few studies have investigated these measures for thyroid hormone replacement therapy (THRT). The purpose of this study was to 1) calculate the agreement between self-report and dispensed prescriptions of...

We thank Dr. Shaligram, author of this Letter to the Editor, for the interest in our recent article reporting time-dependent effects of prenatal exposure to selective serotonin reuptake inhibitors (SSRIs) on behavioral, emotional, and social development in offspring at age 5 years.1 Dr. Shaligram raises interesting points of consideration for inter...

Objectives: 1) To calculate the agreement between self-report and dispensed prescriptions of thyroid hormone replacement therapy (THRT) 2) To classify women with similar adherence patterns to THRT into disjoint longitudinal trajectories

The growing evidence on psychotropic drug safety in pregnancy has been possible thanks to the increasing availability of real-world data, i.e. data not collected in conventional randomised controlled trials. Use of these data is a key to establish psychotropic drug effects on foetal, child, and maternal health. Despite the inherent limitations and...

Antenatal EPDS weighted mean score and 95% CI, overall and by self-reported psychiatric disorder (n=4308). Notes: No EPDS estimate is presented for women with psychiatric disorders in Croatia and Slovenia due to small sample size. Mean values and corresponding 95% CI were survey weight adjusted. The survey weight accounted for educational level wit...

Postnatal EPDS weighted mean score and 95% CI, overall and by self-reported psychiatric disorder (n=3761). Notes: No EPDS estimate is presented for women with psychiatric disorders in Croatia due to low numbers. No estimate is presented for women with psychiatric disorders in Slovenia because of small sample size. Mean values and corresponding 95%...

Balance of covariates (standardized difference) after the application of the IPTW for antidepressant use at any time during pregnancy. Abbreviation: IPTW, inverse probability of treatment weight.

Balance of covariates (standardized difference) after the application of the IPTW for antidepressant use in two or three trimesters. Abbreviation: IPTW, inverse probability of treatment weight.

Purpose: This study aimed at exploring the prevalence of self-reported antenatal and postnatal depressive symptoms by severity across multiple countries and the association between antidepressant treatment in pregnancy and postnatal symptom severity. Materials and methods: This was a multinational web-based study conducted across 12 European cou...

This study explored the impact of women’s personality on drinking and smoking habits before and during pregnancy, using a multinational perspective. Data on maternal personality traits, background information, and alcohol and cigarette smoking before and during pregnancy were collected from 9187 women from more than 18 countries. High conscientious...

Introduction: Approximately 3% to 5% of pregnant women have hypothyroidism. Despite the potential impact of untreated hypothyroidism on infant neurodevelopment, few studies have investigated the risk factors associated with discontinuation of thyroid hormone replacement therapy (THRT) in pregnancy. We aimed to identify such factors in a population...

Objective. To describe Nordic pharmacy students' opinions of their patient communication skills training (PCST), and the association between course leaders' reports of PCST qualities and students' perceptions of their training. Secondary objective was to determine what factors influence these associations.Methods.A cross-sectional questionnaire-bas...

Objective To evaluate the effect of prenatal exposure to selective serotonin reuptake inhibitors (SSRIs) on children’s behavioral, emotional, and social development by age 5 years, and over time since age 1.5. Method The prospective Norwegian Mother and Child Cohort Study was linked to the Medical Birth Registry of Norway. We included women who re...

Appendix 1: Supplementary information to the main text presenting additional details on the Methods and Results sections Appendix 2: Specification of various treatment models and generation of the corresponding stabilized weights in relation to the outcome late‐onset preeclampsia (any severity) (n = 5745) Appendix 3: Risk of late‐onset preeclamps...

Objective: To identify risk factors for discontinuation of thyroid treatment in the 1st trimester of pregnancy among women undergoing hypothyroid treatment prior to pregnancy.

Background and objective A comparison of sick leave in pregnancy between countries is difficult as most studies have been conducted in single countries in Scandinavia. The objective of this study was to explore patterns of and reasons for sick leave during pregnancy on a multinational level, focusing on medication use but also differences in sick l...

Purpose To describe the risk of early‐ and late‐onset preeclampsia across pregnancies exposed to antidepressants and to evaluate the impact of timing and length of gestational exposure to antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs), on preeclampsia. Methods The Norwegian Mother and Child Cohort, a prospective popu...

Data S1 Supplementary Table 1. Medication use according to trimester Supplementary Table 2. Top five potentially risky and unclassified medications by region and used by more than 1% of the sample in the actual region Supplementary Table 3. Association between chronic disorders and use of potentially risky medications during pregnancy

Purpose: The present study describes the safety profile of medications used during pregnancy across European countries and examines maternal factors associated with the use of risky medications during pregnancy. Methods: This study is based on a multinational, web-based study conducted in 15 European countries from October 2011 to February 2012....

Background: Although single-country studies indicate alcohol consumption among some pregnant European women, it is difficult to interpret European differences. Few multinational studies exist using the same methodology. Aim: To estimate the proportion of women consuming alcohol during pregnancy in Europe, and to analyze whether between country v...

Background Previous research has examined the number and extent of medicines taking in pregnant women but not their beliefs and risk perception surrounding their use. Objective To describe beliefs and risk perception associated with medicines use for the treatment of common acute conditions among UK women and explore whether this is related to actu...

Objectives: The objectives of this study were to describe drug use during pregnancy in a context of acute and chronic diseases during pregnancy. An additional aim was to analyze the maternal socio-demographic and lifestyle factors associated with medication use in pregnancy. Methods: Cross-sectional, web-based descriptive study conducted among F...