Advising on Antidepressant Use in Pregnancy: Are We All on the Same Page?

Perinatal mood disorders are associated with adverse maternal and neonatal outcomes and affect 15%-20% of pregnant people. Guidelines recommend SSRIs when non-pharmacological therapies are ineffective, yet antenatal depression remains undertreated. This study aimed to assess the attitudes, knowledge, and practices of general practitioners (GPs) and midwives on SSRI use in pregnancy.

A knowledge, attitudes, and practice survey was developed in QualtricsXM and distributed to New Zealand-registered GPs and midwives between May 2023 and October 2024 using convenience sampling.

Responses from 119 GPs and 62 midwives were analyzed. Discomfort managing antenatal depression was reported by 11% of GPs and 36% of midwives. Knowledge of SSRI risks in pregnancy varied among respondents. Average concern regarding the use of SSRIs in pregnancy and the risk of adverse outcomes was low, but there was considerable variation. In the case vignette, recommended actions differed: 53% advised maintaining treatment, 13% suggested dose reduction, and 24% recommended switching antidepressants. Patient counseling was limited, and appropriate written patient information was rarely provided.

This study highlights variability in knowledge, attitudes, and practices among GP's and midwives regarding SSRIs during pregnancy. Further training, improved access to patient information, and decision aids could enhance patient-centered care and ensure pregnant people receive balanced, evidence-based guidance on SSRI use.