Abstract
Background
Postpartum depression affects 1 in 7 women in the U.S. and antidepressant medications during pregnancy are recommended by obstetric and psychiatric professional societies for select patients with a history of depressive disorders. However, prenatal antidepressant medication use remains controversial, and current evidence does not allow conclusions regarding prenatal antidepressant medication effectiveness in preventing postpartum depression.
Objective
To determine postpartum depression risk in women stopping versus continuing antidepressant medications during pregnancy and examine if risk varies by race, ethnicity, age, and prenatal depressive symptoms. We hypothesized continuing prenatal antidepressant medications would be associated with lower postpartum depression risk.
Study Design
This retrospective cohort study, conducted in a large, diverse, integrated community-based health care system, included patients ≥18 years old with a live birth between 2010-2019 and depression taking antidepressant medication in the year prior to their last menstrual period. Exclusion criteria included bipolar, psychotic, or active substance use disorders. Based on medication fill history, patients were classified as continuing, stopping then restarting, or stopping antidepressant medications during pregnancy. Postpartum depression was defined as an international classification of diseases diagnostic code or a patient health questionnaire (PHQ)-9 score of ≥10 up to a year after delivery. PHQ-9 scores of 0-4 define none-minimal, 5-9 mild, 10-14 moderate, 15-19 moderately-severe, and ≥20 severe symptoms.
Results
Of 6,552 patients who continued (n=2,216), stopped then restarted (n=1,258), or stopped (n=3,078) antidepressant medications during pregnancy, 37.7% (n=2,469) developed postpartum depression. Compared to continuing, stopping then restarting or stopping antidepressant medications during pregnancy was associated with a higher risk of postpartum depression (adjusted relative risk (aRR)=1.14, 95%CI:1.05-1.24 and 1.14, 95%CI:1.06-1.22 moderate-severe depression and 1.33, 95%CI:1.09-1.62 severe depression for stopping). Risk was higher for patients with at least mild depressive symptoms at the first pregnancy depression screening (50.8% of patients; aRR=1.55; 95%CI 1.45-1.65), and highest for women with symptoms and stopping their antidepressant during pregnancy (aRR=2.72, 95%CI 1.94-3.82) compared to patients continuing antidepressants with none-minimal depressive symptoms. There were no statistically significant interactions by race, ethnicity, or age.
Conclusions
Antidepressant medications during pregnancy may benefit patients with past depressive disorders to prevent postpartum depression. Depressive symptom severity during pregnancy may inform shared treatment decision-making between patients and prescribers.