TOPLINE

Continuing antidepressant medications during pregnancy is associated with a lower postpartum depression risk in women with a history of depression than stopping or stopping and then restarting medication. Among 6552 pregnant patients with major depressive disorders who were taking antidepressants, those who stopped their medication had a 14% higher risk for postpartum depression and a 33% higher risk for severe postpartum depression.

METHODOLOGY

• Researchers conducted a retrospective cohort study within Kaiser Permanente Northern California (KPNC), a large, diverse, integrated, community-based healthcare system, including patients older than 18 years with a live birth between 2010 and 2019 and depression who were taking antidepressant medications in the year prior to their last menstrual period.
• A total of 6552 patients were included after excluding those with bipolar, psychotic, or active substance use disorders; patients were classified on the basis of medication fill history as continuing (n = 2216), stopping and then restarting (n = 1258), or stopping (n = 3078) antidepressant medications during pregnancy.
• Postpartum depression was defined as an International Classification of Diseases (ICD) diagnostic code or a nine-item Patient Health Questionnaire (PHQ-9) score of ≥ 10 up to a year after delivery, with PHQ-9 scores of 0-4 defining none to minimal symptoms; 5-9, mild; 10-14, moderate; 15-19, moderately severe; and > 20, severe symptoms.
• Analysis included evaluation of postpartum depression risk by antidepressant medication status during pregnancy and examination of whether risk varied by race, ethnicity, age, and prenatal depressive symptoms using multivariate modified Poisson regression while controlling for covariates.

TAKEAWAY

• Compared to continuing antidepressant medications during pregnancy, stopping and then restarting was associated with a 14% higher risk for postpartum depression (adjusted relative risk [ARR], 1.14; 95% CI, 1.05-1.24), and stopping was associated with a 14% higher overall risk (ARR, 1.14; 95% CI, 1.06-1.22) and a 33% higher risk for severe postpartum depression (ARR, 1.33; 95% CI, 1.09-1.62).
• At least mild depressive symptoms (PHQ-9 score ≥ 5) at the first pregnancy depression screening were associated with a 55% higher risk for postpartum depression overall (ARR, 1.55; 95% CI, 1.45-1.65) and more than double the risk for severe postpartum depression (ARR, 2.10; 95% CI, 1.76-2.52), independent of antidepressant medication status.
• Patients who stopped antidepressant medications and had at least mild depressive symptoms during pregnancy had the highest risk for severe postpartum depression (ARR, 2.72; 95% CI, 1.94-3.82) compared with patients continuing antidepressants with none-to-minimal depressive symptoms.
• There were no statistically significant interactions between race, ethnicity, or age and antidepressant medication status on the postpartum depression risk (P > .05).

IN PRACTICE

“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,” the authors of the study wrote.

SOURCE

The study was led by Kathryn K. Ridout, MD, PhD, The Permanente Medical Group, KPNC, Pleasanton, California. It was published online in the American Journal of Obstetrics & Gynecology.

LIMITATIONS

According to the authors, retrospective studies are susceptible to unmeasured confounding, misclassification bias, and missing data. The PHQ-9 includes somatic symptom measurements, which may make it less useful despite somatic symptoms being highly related to emotional-cognitive symptoms. The study occurred in an integrated healthcare system with insured patients, so some findings may not generalize to other populations. There may be disruptions in observed rates related to the ICD-9 to ICD-10 coding transitions. Patients stopping antidepressants had lower PHQ-9 scores and lower postpartum depression history rates but higher postpartum depression risk, which the authors suggest supports finding validity.

DISCLOSURES

This study received support from The Permanente Medical Group Biostatistical Consulting Unit, NIMH-R01MH132973 (Ridout), and The Permanente Medical Group’s Physician Researcher Program. The authors disclosed no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.