Antidepressant use in pregnancy: knowledge transfer and translation of research findings

Abstract

Background: Knowledge Transfer and Translation(KT) has become an important component in health care systems worldwide. Antidepressant use in pregnancy has become a controversial subject for a number of reasons, including differing interpretations of study results. An important question then arises as to how knowledge derived from studies is effectively disseminated to the stakeholders who need this information to be able to use and apply in various situations. A relatively new field in science has been emerging, that addresses the issue of ensuring that information generated from research, reaches the right people in the right format. This has been coined knowledge transfer and exchange or knowledge translation (KT). Although KT is now accepted practice among many public health leaders internationally, its potential to advance the quality of health of women during the perinatal period has not been fully examined. Objectives: (1) to determine how knowledge regarding the safety/risk of antidepressant use in pregnancy is created, (2) to describe different research models and statistical analyses that have been used, so as to critically evaluate the results, and (3) to identify how this information is currently disseminated. Methods: Selected key articles were indentified and retrieved from the literature. Relevant information was extracted and synthesized into themes, addressing each of the stated objectives. Results: All of the methods used for examining the safety of antidepressants in pregnancy have some deficiencies in study design and analysis, thus reinforcing the need for accurate interpretations when discussing results. In addition, dissemination in both the scientific and lay press, has been selective and therefore potentially biased. Conclusions: It is unlikely that in the near future, pregnant women will be included in randomized controlled trials, so studying the safety/risk of antidepressants in pregnancy is observational research. All of the methods used have some deficiencies in study design and analysis, thus reinforcing the need for improved rigor.. However, this does not mean that the information provided from the results of these studies is not valuable, as long as the methodology and analysis are critically evaluated and understood by the reader. It is apparent from this research, that (KT) has become an important component in the health care system. Consequently, it is critical that the current gaps between the creation of knowledge and ultimately to translating and transferring information to the patient are closed. This includes improving the methodology of the studies and unambiguous, dissemination of the results, so clinicians are capable of evaluating whether the results have clinical significance or not. It is critical, starting with the creators of knowledge, through to the recipients, that discrepancies are resolved, as lack of clarity may impede the transfer of unambiguous evidence-based information from health care providers to patients, thus impacting decision-making. For example, by implementing improved (KT) strategies, a pregnant, depressed woman, will be empowered to make a rational evidence-based decision regarding whether or not she should take an antidepressant during pregnancy.