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

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.

Keywords

anxiety - depression - psychotropic medication - maternal outcome - neonatal outcome - neonatal adaptation syndrome

Presentation

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

• References

• 1 Biaggi A, Conroy S, Pawlby S, Pariante CM. Identifying the women at risk of antenatal anxiety and depression: a systematic review. J Affect Disord 2016; 191: 62-77
• 2 Gavin NI, Gaynes BN, Lohr KN, Meltzer-Brody S, Gartlehner G, Swinson T. Perinatal depression: a systematic review of prevalence and incidence. Obstet Gynecol 2005; 106 (5 Pt 1): 1071-1083
• 3 Fisher J, Cabral de Mello M, Patel V. , et al. Prevalence and determinants of common perinatal mental disorders in women in low- and lower-middle-income countries: a systematic review. Bull World Health Organ 2012; 90 (02) 139G-149G
• 4 Betts KS, Williams GM, Najman JM, Scott J, Alati R. The association between lower birth weight and comorbid generalised anxiety and major depressive disorder. J Affect Disord 2013; 146 (02) 231-237
• 5 Howard LM, Molyneaux E, Dennis CL, Rochat T, Stein A, Milgrom J. Non-psychotic mental disorders in the perinatal period. Lancet 2014; 384 (9956): 1775-1788
• 6 Hanley GE, Mintzes B. Patterns of psychotropic medicine use in pregnancy in the United States from 2006 to 2011 among women with private insurance. BMC Pregnancy Childbirth 2014; 14: 242
• 7 Huybrechts KF, Bateman BT, Palmsten K. , et al. Antidepressant use late in pregnancy and risk of persistent pulmonary hypertension of the newborn. JAMA 2015; 313 (21) 2142-2151
• 8 Grigoriadis S, Vonderporten EH, Mamisashvili L. , et al. Prenatal exposure to antidepressants and persistent pulmonary hypertension of the newborn: systematic review and meta-analysis. BMJ 2014; 348: f6932
• 9 Lorenzo L, Einarson A. Antidepressant use in pregnancy: an evaluation of adverse outcomes excluding malformation. Isr J Psychiatry Relat Sci 2014; 51 (02) 94-104
• 10 Räisänen S, Lehto SM, Nielsen HS, Gissler M, Kramer MR, Heinonen S. Risk factors for and perinatal outcomes of major depression during pregnancy: a population-based analysis during 2002-2010 in Finland. BMJ Open 2014; 4 (11) e004883
• 11 Faisal-Cury A, Rossi Menezes P. Prevalence of anxiety and depression during pregnancy in a private setting sample. Arch Women Ment Health 2007; 10 (01) 25-32
• 12 Fellenzer JL, Cibula DA. Intendedness of pregnancy and other predictive factors for symptoms of prenatal depression in a population-based study. Matern Child Health J 2014; 18 (10) 2426-2436
• 13 Gavin AR, Melville JL, Rue T, Guo Y, Dina KT, Katon WJ. Racial differences in the prevalence of antenatal depression. Gen Hosp Psychiatry 2011; 33 (02) 87-93
• 14 Melville JL, Gavin A, Guo Y, Fan MY, Katon WJ. Depressive disorders during pregnancy: prevalence and risk factors in a large urban sample. Obstet Gynecol 2010; 116 (05) 1064-1070
• 15 Redshaw M, Henderson J. From antenatal to postnatal depression: associated factors and mitigating influences. J Womens Health (Larchmt) 2013; 22 (06) 518-525
• 16 Shakeel N, Eberhard-Gran M, Sletner L. , et al. A prospective cohort study of depression in pregnancy, prevalence and risk factors in a multi-ethnic population. BMC Pregnancy Childbirth 2015; 15: 5
• 17 Verreault N, Da Costa D, Marchand A, Ireland K, Dritsa M, Khalifé S. Rates and risk factors associated with depressive symptoms during pregnancy and with postpartum onset. J Psychosom Obstet Gynaecol 2014; 35 (03) 84-91
• 18 Shen JJ, Lin F, Jackson T. Risk of prenatal depression: differences by race. Ethn Dis 2010; 20 (01) 35-39
• 19 Prady SL, Pickett KE, Croudace T. , et al. Psychological distress during pregnancy in a multi-ethnic community: findings from the born in Bradford cohort study. PLoS One 2013; 8 (04) e60693
• 20 Jesse DE, Walcott-McQuigg J, Mariella A, Swanson MS. Risks and protective factors associated with symptoms of depression in low-income African American and Caucasian women during pregnancy. J Midwifery Womens Health 2005; 50 (05) 405-410
• 21 Kuo SY, Chen SR, Tzeng YL. Depression and anxiety trajectories among women who undergo an elective cesarean section. PLoS One 2014; 9 (01) e86653
• 22 Waqas A, Raza N, Lodhi HW, Muhammad Z, Jamal M, Rehman A. Psychosocial factors of antenatal anxiety and depression in Pakistan: is social support a mediator?. PLoS One 2015; 10 (01) e0116510
• 23 Adewuya AO, Ola BA, Aloba OO, Dada AO, Fasoto OO. Prevalence and correlates of depression in late pregnancy among Nigerian women. Depress Anxiety 2007; 24 (01) 15-21
• 24 Ajinkya S, Jadhav PR, Srivastava NN. Depression during pregnancy: prevalence and obstetric risk factors among pregnant women attending a tertiary care hospital in Navi Mumbai. Ind Psychiatry J 2013; 22 (01) 37-40
• 25 Chung TK, Lau TK, Yip AS, Chiu HF, Lee DT. Antepartum depressive symptomatology is associated with adverse obstetric and neonatal outcomes. Psychosom Med 2001; 63 (05) 830-834
• 26 Olieman RM, Siemonsma F, Bartens MA, Garthus-Niegel S, Scheele F, Honig A. The effect of an elective cesarean section on maternal request on peripartum anxiety and depression in women with childbirth fear: a systematic review. BMC Pregnancy Childbirth 2017; 17 (01) 195
• 27 Venkatesh KK, Riley L, Castro VM, Perlis RH, Kaimal AJ. Association of antenatal depression symptoms and antidepressant treatment with preterm birth. Obstet Gynecol 2016; 127 (05) 926-933
• 28 Einarson A, Selby P, Koren G. Abrupt discontinuation of psychotropic drugs during pregnancy: fear of teratogenic risk and impact of counselling. J Psychiatry Neurosci 2001; 26 (01) 44-48
• 29 Cohen LS, Altshuler LL, Harlow BL. , et al. Relapse of major depression during pregnancy in women who maintain or discontinue antidepressant treatment. JAMA 2006; 295 (05) 499-507
• 30 Silverman ME, Reichenberg A, Savitz DA. , et al. The risk factors for postpartum depression: a population-based study. Depress Anxiety 2017; 34 (02) 178-187
• 31 Eke AC, Saccone G, Berghella V. Selective serotonin reuptake inhibitor (SSRI) use during pregnancy and risk of preterm birth: a systematic review and meta-analysis. BJOG 2016; 123 (12) 1900-1907
• 32 Correa-Villaseñor A, Stewart WF, Franco-Marina F, Seacat H. Bias from nondifferential misclassification in case-control studies with three exposure levels. Epidemiology 1995; 6 (03) 276-281
• 33 Keyloun KR, Hansen RN, Hepp Z, Gillard P, Thase ME, Devine EB. Adherence and persistence across antidepressant therapeutic classes: a retrospective claims analysis among insured US patients with major depressive disorder (MDD). CNS Drugs 2017; 31 (05) 421-432