LAS VEGAS — A high number of patients stopped or interrupted their use of antidepressants during pregnancy, according to a cross-sectional study.
In an analysis of a Pennsylvania insurance database, just 17.6% of 1,462 patients who delivered babies in 2023 or 2024 continued their antidepressants in pregnancy without gaps while 17.8% had no fills during pregnancy and 64.6% had a gap of 60 days or more, reported Kelly Zafman, MD, of the Hospital of the University of Pennsylvania in Philadelphia, during a presentation at the Society for Maternal-Fetal Medicine (SMFM) annual meeting.
The authors also found that patients who discontinued antidepressants in pregnancy had 562 more emergency visits for a behavioral health indication from the start of pregnancy to 8 months postpartum compared to those who continued their medications (1,357 vs 795). This was especially present in the first trimester, which had 58 compared to 37 mental health emergency visits per 1,000 patients (P=0.027) and the third trimester and immediate postpartum period, which had 59 per 1,000 compared to 19 (P=0.001).
“This work underscores the need to take pregnant patients’ mental health seriously and to offer the full range of treatment options — including medications when clinically appropriate,” Zafman said in an SMFM press release. “Confronting the maternal mental health crisis is essential to reducing maternal morbidity and mortality in the United States.”
One in five patients already have a diagnosis of anxiety or depression when entering pregnancy, which can have adverse effects on maternal, obstetric, and neonatal outcomes if left untreated. Zafman highlighted that the data are “clear that treatment of mental health disorders in pregnancy significantly mitigates the harms of these conditions.” She added that may includes antidepressants.
“Though no medications are without risks, the risks of untreated mental health disorders significantly outweigh the theoretical risks in pregnancy,” Zafman stated.
The American College of Obstetricians & Gynecologists “recommends against withholding or discontinuing medications for mental health conditions due to pregnancy or lactation status alone.” Despite this, prior research suggested that more than half of patients discontinue their antidepressants prior to pregnancy, most often in the first trimester, Zafman said.
The current findings aligned with the trend: antidepressants were most often discontinued in the first trimester (44.9%), with 30.3% discontinuing use in the third trimester and 24.8% in the second.
Authors analyzed data from Independence Blue Cross, a Pennsylvania private insurance database. This was linked to pharmacy claims data, allowing researchers to measure medication fills, a more solid indicator of medication use than prescription alone. They used diagnosis-related group (DRG) codes to identify deliveries, ICD-10 codes to identify depression and anxiety diagnoses, and Generic Product Identifier (GPI) codes to identify prescriptions for selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs).
Patients with an active SSRI or SNRI prescription for 3 months prior to pregnancy were included. The most common mental health diagnosis was an anxiety disorder (79%), while 29.7% had a depressive disorder, 19.2% had attention-deficit/hyperactivity disorder (ADHD), and 5.9% had adjustment disorder.
The most common prescribers of antidepressants during pregnancy were family medicine doctors (22.8%) followed by primary care or women’s health nurse practitioners (18.8%) and ob/gyns (18.2%). The rate of medication discontinuation differed significantly by prescriber specialty (P<0.001) with discontinuation least likely when prescribed by ob/gyns compared to family medicine and internal medicine prescribers.
David Hackney, MD, of Case Western Reserve University in Cleveland, told Medpage Today he wasn’t surprised that the lowest rate of medication discontinuation was with ob/gyn prescribers because they are the most comfortable making medical decisions for pregnant patients.
“The thing that I really liked about this study was that it had hard, definitive exposures and outcomes,” noted Hackney, who was not involved in the research. “They had the pharmacy data showing that the patients had not filled the script.”
There were no significant differences between the groups in regards to patient age, timing of prenatal care initiation, or number of outpatient behavioral health visits in the year before pregnancy. Mean age was 33.2. A majority (88.0%) were white and had higher than high school education (79.1%). Patients who continued taking antidepressants had higher mean numbers of prenatal visits during pregnancy (6.5 vs 7.0, P<0.01), though Zafman said this was likely not clinically significant.
She encouraged future research to assess the racial disparities in medication discontinuation and to develop strategies to encourage patients to continue taking their prescribed medications.