Comparing Newborn Outcomes After Prenatal Exposure to Individual Antidepressants

Background: Up to 1 out of 5 women experience depression during their childbearing years, with 20-33% treating with drugs. However, data are limited on individual drugs’ effects on pregnancy outcomes. The objective of this study was to compare associations between individual antidepressants and pregnancy outcomes. Study Methods: Deidentified demographic, medical and obstetric data from women who received at least one antidepressant (SSRI or SNRI) prescription prior to conception through delivery were obtained from Regenstrief Institute. Drugs were were compared using standard statistics and multivariable regression. Results: A total of 3801 women took bupropion (n=311), citalopram (n=355), fluoxetine (n=520), sertraline (n=1557), duloxetine (n=112), escitalopram (n=534), venlafaxine (n=105), paroxetine (n=45), desvenlafaxine (n=12), or multiple antidepressants (n=250). Most women were white (86.5%), and had either commercial (50.3%) or government (48.1%) insurance. Race (p=0.002), hospital (p<0.001), and insurance (p<0.001) were associated with selection of drug. Incidence of diabetes (p<0.001), gestational diabetes (p=0.005), hypertension (p=0.015), and gestational hypertension (p=0.006) varied between drugs, with highest rates in women taking duloxetine. NICU admission (p<0.001), transient tachypnea of newborn (TTN) (p=0.001), and adaptation syndrome (p<0.001) were significantly different between drugs, with duloxetine having highest NICU admission (42.9%) and TTN (20.5%). Paroxetine was associated with higher rates of adaptation syndrome (13.3%). After controlling for maternal age, race, hospital, and insurance, adaptation syndrome was increased with citalopram OR[95%CI] = 2.358[1.147-4.849], duloxetine 3.180[1.362-7.424], escitalopram 2.832[1.418], paroxetine 3.347[1.138-9.847], and multiple drugs 2.603[1.222-5.545] compared to bupropion. Adding hypertension and diabetes to the model above, increased NICU admission rates were seen with citalopram 1.498[1.036-2.168], fluoxetine 1.565[1.109-2.208], duloxetine 2.568[1.593-4.139], escitalopram 2.045[1.458-2.869], and multiple drugs 2.009[1.362-2.964] compared to bupropion. Conclusion: Different antidepressants have associations with individual maternal and newborn outcomes. Duloxetine and paroxetine appear to have the strongest associations with NICU admission and adaptation syndromes, respectively. These outcomes require further investigation by exposure trimester.

The LOINC RSNA radiology playbook - a unified terminology for radiology procedures

Objective This paper describes the unified LOINC/RSNA Radiology Playbook and the process by which it was produced. Methods The Regenstrief Institute and the Radiological Society of North America (RSNA) developed a unification plan consisting of six objectives 1) develop a unified model for radiology procedure names that represents the attributes with an extensible set of values, 2) transform existing LOINC procedure codes into the unified model representation, 3) create a mapping between all the attribute values used in the unified model as coded in LOINC (ie, LOINC Parts) and their equivalent concepts in RadLex, 4) create a mapping between the existing procedure codes in the RadLex Core Playbook and the corresponding codes in LOINC, 5) develop a single integrated governance process for managing the unified terminology, and 6) publicly distribute the terminology artifacts. Results We developed a unified model and instantiated it in a new LOINC release artifact that contains the LOINC codes and display name (ie LONG_COMMON_NAME) for each procedure, mappings between LOINC and the RSNA Playbook at the procedure code level, and connections between procedure terms and their attribute values that are expressed as LOINC Parts and RadLex IDs. We transformed all the existing LOINC content into the new model and publicly distributed it in standard releases. The organizations have also developed a joint governance process for ongoing maintenance of the terminology. Conclusions The LOINC/RSNA Radiology Playbook provides a universal terminology standard for radiology orders and results.