Antidepressant Continuation in Pregnancy and Postpartum Depression Risk Across Racial and Ethnic Groups

Area of Science:

• Reproductive Psychiatry
• Perinatal Mental Health
• Pharmacological Interventions

Background:

• Postpartum depression (PPD) affects 1 in 7 women in the U.S.
• Prenatal antidepressant use is recommended for some but remains controversial.
• Evidence on effectiveness in preventing PPD is limited.

Purpose of the Study:

• To determine PPD risk in women stopping versus continuing antidepressants during pregnancy.
• To examine if PPD risk varies by race, ethnicity, age, and prenatal depressive symptoms.
• Hypothesized that continuing prenatal antidepressants would lower PPD risk.

Main Methods:

• Retrospective cohort study of 6,552 women with depression on antidepressants before pregnancy.
• Classified patients into continuing, stopping/restarting, or stopping antidepressants during pregnancy.
• Defined PPD using ICD codes or PHQ-9 scores (≥10) up to one year postpartum.

Main Results:

• 37.7% of women developed PPD.
• Stopping or stopping/restarting antidepressants increased PPD risk compared to continuing.
• PPD risk was higher with prenatal depressive symptoms, especially when stopping medication (aRR=2.72).
• No significant interactions found for race, ethnicity, or age.

Conclusions:

• Antidepressant medication during pregnancy may help prevent PPD in women with a history of depressive disorders.
• Prenatal depressive symptom severity is crucial for shared treatment decision-making.
• Personalized management of antidepressant use during pregnancy is recommended.