More than 80% of pregnant patients stopped or interrupted their medications during gestation, which was associated with nearly double the risk for an emergency visit for mental health reasons, according to a study presented at the Society for Maternal-Fetal Medicine (SMFM) 2026 Annual Pregnancy Meeting in Las Vegas. 

Study participants most commonly discontinued and visited emergency departments (EDs) for behavioral health issues during the first and late third trimesters.

“Confronting the maternal mental health crisis is essential to reducing maternal morbidity and mortality in the United States,” said Kelly B. Zafman, MD, a third year maternal-fetal medicine fellow at the University of Pennsylvania in Philadelphia, who presented the results.

“We must be the experts and advocates on antidepressant medications in pregnancy. If not — who is?” she said. “Our voices will be filled by the voices of the nonexperts.”

Anxiety and depression affect an estimated 1 in 5 pregnant patients, and suicide is the leading cause of maternal deaths, responsible for up to 20% of all maternal deaths globally.

The American College of Obstetricians and Gynecologists recommends against withholding or discontinuing medications for mental health conditions solely due to pregnancy or lactation.

Untreated and undertreated mental health disorders, such as anxiety, schizophrenia, and bipolar disorder are linked to an increased risk for preeclampsia, low birth weight, and neurodevelopmental delays in children, studies have showed.

To understand patterns in antidepressant use, Zafman and her colleagues conducted a cross-sectional analysis of pharmacy claims data from Pennsylvania IBX, a private insurance database. They assessed how many selective serotonin reuptake inhibitors (SSRI) or serotonin-norepinephrine reuptake inhibitor prescriptions were filled for patients who delivered in 2023 and 2024.

Among 1462 patients (average age, 33 years; 88% White), the most common diagnosis was anxiety (74%), followed by depressive disorder (29.7%), attention-deficit/hyperactivity disorder (19.2%), and adjustment disorder (5.9%). The most common prescribers were a family medicine physician (22.8%), primary care or women's health nurse practitioner (18.8%), ob/gyn (18.2%), a psychiatrist or psychiatry nurse practitioner (14.4%), and an internal medicine physician (8.9%).

Patients whose antidepressants were prescribed by an ob/gyn had the lowest rate of discontinuation during pregnancy compared to other providers (P < .001). 

Most of the patients (64.6%) had at least a 60-day gap in filling their medication during pregnancy, and 17.8% had no medication fills during pregnancy. Only 17.6% continued filling their medication without interruptions. Nearly half of those who stopped or interrupted their medication during pregnancy did so during the first trimester.

Rates of outpatient behavioral health visits did not change substantially before, during, or after pregnancy for those who continued their medications or those who interrupted them.

No significant differences in the rates of ED visits were shown prior to pregnancy. The rates diverged after pregnancy began.

At the start of pregnancy, ED visits increased for patients who stopped their antidepressants, peaking in the second month of pregnancy at 58 visits per 1000 patients compared to 37 visits per 1000 for those who continued their medication (P = .027).

Another substantial peak occurred during the late third trimester, when 59 ED visits occurred per 1000 patients for those not taking medication and 29 per 1000 for those continuing medication (P =.001).

After delivery, rates of visits continued to be significantly higher among those who stopped or interrupted their medication than among those who did not stop.

Clinical Implications

The study’s findings were not surprising to Rubiahna L. Vaughn, MD, MPH, an associate professor of psychiatry and ob/gyn and women’s health at the Albert Einstein College of Medicine and director of the Division of Women’s Mental Health at Montefiore Medical Center, both in New York City, who was not involved with the study.

“It confirms everything that we know to be true, which is that the impact of untreated or undertreated mental illness in the perinatal period is quite significant, and when patients don’t get their medicine, there’s a high morbidity associated with that,” Vaughn told Medscape Medical News.

Many pregnant patients fear antidepressants will have a negative effect on their pregnancy, Zafman said. But she said clinicians may also have similar misconceptions and fears or be uncomfortable counseling patients on this issue.

In some cases, a patient’s partner is opposed to any psychotropic medications during pregnancy, which can also contribute to stigma and sway decisions, Vaughn said.

Meanwhile, over two decades of data show that SSRI are not teratogenic.

Depression during the postpartum period also interferes with developing a healthy attachment to infants, and children of mothers with untreated depression “are more likely to grow up and struggle with mood and anxiety and intentional disorders themselves,” Vaughn said. “The risks here are tremendous.”

Zafman noted that an FDA Expert Panel in July 2025 reviewed the safety of SSRI in pregnancy, which “highlighted old data about medication risks with little discussion about risks of untreated mental health disorders.”

Changes suggested to the FDA, such as a black box warning on antidepressants in pregnancy, “would cause significant harm to our patients,” Zafman said.

No external funding was noted for the study. Zafman and Vaughn reported having no disclosures.

Tara Haelle is a science/health journalist based in Dallas.