CC BY-NC-ND 4.0 · AJP Rep 2018; 08(03): e146-e157
DOI: 10.1055/s-0038-1661379
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The Contribution of Untreated and Treated Anxiety and Depression to Prenatal, Intrapartum, and Neonatal Outcomes

Dotun Ogunyemi
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Beaumont Hospital, Royal Oak, Michigan
Department of Obstetrics and Gynecology, Oakland University, William Beaumont School of Medicine, Rochester Hills, Michigan
,
Andrew Jovanovski
Department of Obstetrics and Gynecology, Oakland University, William Beaumont School of Medicine, Rochester Hills, Michigan
,
James Liu
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Beaumont Hospital, Royal Oak, Michigan
Department of Obstetrics and Gynecology, Oakland University, William Beaumont School of Medicine, Rochester Hills, Michigan
,
Perry Friedman
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Beaumont Hospital, Royal Oak, Michigan
Department of Obstetrics and Gynecology, Oakland University, William Beaumont School of Medicine, Rochester Hills, Michigan
,
Nathaniel Sugiyama
University of Vermont Robert Larner College of Medicine, Burlington, Vermont
,
James Creps
Department of Obstetrics and Gynecology, Oakland University, William Beaumont School of Medicine, Rochester Hills, Michigan
,
Ichchha Madan
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Beaumont Hospital, Royal Oak, Michigan
Department of Obstetrics and Gynecology, Oakland University, William Beaumont School of Medicine, Rochester Hills, Michigan
› Author Affiliations
Further Information

Publication History

15 August 2017

23 February 2018

Publication Date:
10 July 2018 (online)

Abstract

Objective To determine independent perinatal associations of anxiety and depression in women who were and were not treated with psychotropic drugs in comparison to unaffected pregnancies.

Study Design From 2013 to 2014, 978 (6.3%) cases of anxiety/depression, of which 35% used psychotropic drugs, were compared with 14,514 (93.7%) unaffected pregnancies using logistic regression.

Results Subjects were more likely to be Non-Hispanic Whites, use tobacco and illegal substances, be unmarried, use public insurance, and have medical complications of pregnancy. For independent maternal outcomes, untreated anxiety/depression was associated with labor induction (adjusted odds ratio [aOR] = 2.02), cesarean deliveries (aOR = 1.69), longer length of stay (aOR = 1.96), readmission (aOR = 2.40), fever (aOR = 2.03), magnesium exposure (aOR = 1.82), and postpartum hemorrhage (aOR = 2.57), whereas treated cases were associated with increased blood transfusion (aOR = 4.81), severe perineal lacerations (aOR = 2.93), and postpartum hemorrhage (aOR = 3.85), but decreased risk of cesarean deliveries (aOR = 0.59). Independent neonatal outcomes included small for gestational age (aOR = 3.04), meconium-stained fluid (aOR = 1.85; 2.61), respiratory failure (aOR = 5.84), neonatal adaptation syndrome (aOR = 11; 10.2), and neonatal seizures (aOR = 12.3) in treated cases, whereas untreated cases were associated with hypoxia (aOR = 2.83), low Apgar score (aOR = 3.82), and encephalopathy (aOR = 18.3). Exposure to multiple psychotropic medications independently increased the risk of neonatal adaptation syndrome, neonatal length of stay, and hypoglycemia.

Conclusion Untreated cases were associated with increased maternal adverse outcomes, whereas treated cases were associated with more adverse neonatal outcomes when compared with unaffected pregnancies.

Presentation

Paper was presented at the 2017 Annual Clinical and Scientific Meeting of the American College of Obstetrician and Gynecologists, San Diego, California.