Background: Adverse obstetric outcomes, including preterm birth and low birth weight, have been linked to maternal depression. Given the broad exclusion of pregnant patients from clinical trials, limited evidence exists on the efficacy of depression management, particularly utilizing antidepressant treatments (ADTs), during pregnancy.
Objectives: To describe maternal patient characteristics and depression severity among women with depression or anxiety by whether treatment with antidepressants was discontinued vs. maintained during pregnancy.
Methods: This retrospective study used claims data from Komodo Research Dataset linked to EHR-derived data from Komodo Clinical Observations between 01/01/2016–08/30/2023 to identify adult women with a known gestation of pregnancy record and end of pregnancy outcome. In addition to having an anxiety or major depressive disorder (MDD) diagnosis (≥1 inpatient or ≥2 non-inpatient claim) and ≥1 ADT claim during the year prior to derived pregnancy start (index date), eligible patients were further required to be continuously enrolled in medical and prescription drug plans for both 365 days before (baseline) and after (follow-up) the index date. Patient health questionnaire-9 (PHQ-9) scores recorded during the baseline and follow-up were utilized to measure depression severity.
Results: Among the 1,234 pregnant women included in the analyses (mean age: 30.2 years), a majority of patients (72.6%) discontinued their baseline ADT before the end of pregnancy. Selective serotonin reuptake inhibitor (SSRI) monotherapy were the most common type of ADT used in the baseline in both cohorts (discontinued: 74.4%; maintained: 80.2%). Commercial medical insurance was less common (49.3% vs. 73.7%) among patients who discontinued vs. maintained their ADT and Medicaid enrollment was more common (47.9% vs. 24.3%) upon pregnancy start. The proportion of patients with moderate to severe depression (PHQ-9 score ≥10) was lower among patients that maintained vs. discontinued ADT use both during the baseline (42.3% vs. 54.4%, respectively) and follow-up (31.4% vs. 39.3%).
Conclusions: Patients who maintained their ADT use throughout pregnancy had lower depression severity both before and after the start of pregnancy relative to those who discontinued. Regardless of whether ADT use was maintained throughout pregnancy, a decrease in depression severity was observed during follow-up relative to baseline, with patients who discontinued ADT experiencing a larger decrease. Additional research should be conducted to identify and address factors driving these differences, including socioeconomic status, and the overall decrease among patients who discontinued.
