Abstract
Obstetrician-gynecologists (ob-gyns) are well-positioned to detect symptoms of perinatal depression; however, little is known about how ob-gyns respond. The purpose of this study was to evaluate ob-gyns’ beliefs and practices related to prenatal depression screening and antidepressant prescription during pregnancy. A larger survey on prenatal medication was developed at the American College of Obstetricians and Gynecologists (ACOG) and distributed to a sample of 1000 Fellows. The overall response rate was 37.9% (N = 379). Two hundred eighty-eight provided care to pregnant patients and therefore, responded to questions on prenatal depression screening and antidepressant prescription. Most ob-gyns (87.8%) routinely screened patients for depression at least once during pregnancy. When symptoms of depression were reported, 52.1% “sometimes” prescribed an antidepressant medication with 22.5% doing so “usually or always”. While 84.0% prescribed selective serotonin reuptake inhibitors (SSRIs) to pregnant patients, only 31.9% prescribed non-SSRIs. Ob-gyns felt comfortable prescribing SSRIs (78.1%) and counseled patients that the benefits of treating depression pharmacologically outweigh the risks (83.0%), and the use of SSRIs during pregnancy is relatively safe (87.5%). Prescribing SSRIs to pregnant patients was not significantly associated with interpretation of evidence on fetal and neonatal outcomes. Findings suggest most ob-gyns in the USA at least sometimes prescribe antidepressants in response to patient reports of depression symptoms during pregnancy. Mixed interpretations of evidence regarding the effects of SSRIs on fetal and neonatal outcomes reflect a critical need for high-quality safety data upon which to base treatment recommendations.
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References
ACOG Committee on Obstetric Practice (2015) Screening for perinatal depression. Obstet Gynecol 125:1268–1271
ACOG Committee on Practice Bulletins—Obstetrics (2008) ACOG practice bulletin: clinical management guidelines for obstetrician-gynecologists number 92 (2008) use of psychiatric medications during pregnancy and lactation. Obstet Gynecol 111(4):1001–1020
American College of Obstetricians and Gynecologists (ACOG) Perinatal Depression Task Force (2008) Perinatal depression screening tools for obstetrician-gynecologists. American College of Obstetricians and Gynecologists, Albany
Bonari L, Pinto N, Ahn E, Einarson A, Steiner M, Koren G (2004) Perinatal risks of untreated depression during pregnancy. Can J Psychiatry 49(11):726–735
Coleman VH, Carter MM, Morgan MA, Schulkin J (2008) United States obstetrician-gynecologists’ accuracy in the simulation of diagnosing anxiety disorders and depression during pregnancy. J Psychosom Obstet Gynecol 29(3):177–188
Cooper WO, Willy ME, Pont SJ, Ray WA (2007) Increasing use of antidepressants in pregnancy. Am J Obstet Gynecol 196(6):544.e1–544.e5
Cunningham CT, Quan H, Hemmelgarn B et al (2015) Exploring physician specialist response rates to web-based surveys. BMC Med Res Methodol 15(32):1–8
Davalos DB, Yadon CA, Tregellas HC (2012) Untreated prenatal maternal depression and the potential risks to offspring: a review. Arch Women’s Ment Health 15(1):1–14
Field T, Diego M, Hernandez-Reif M (2006) Prenatal depression effects on the fetus and newborn: a review. Infant Behav Dev 29(3):445–455
Gaynes BN, Gavin N, Meltzer-Brody S et al (2005) Perinatal depression: prevalence, screening accuracy, and screening outcomes. Evid Rep Technol Assess (Summ) 119:1–8
Gelenberg AJ, Freeman MP, Markowitz JC et al (2010) Practice guideline for the treatment of patients with major depressive disorder, third edition. Am J Psychiatry 167(10):69–71
Kieviet N, Dolman KM, Honig A (2013) The use of psychotropic medication during pregnancy: how about the newborn? Neuropsychiatr Dis Treat 9:1257–1266
Lattimore KA, Donn SM, Kaciroti N, Kemper AR, Neal CR, Vazquez DM (2005) Selective serotonin reuptake inhibitor (SSRI) use during pregnancy and effects on the fetus and newborn: a meta-analysis. J Perinatol 25(9):595–604
Leddy MA, Lawrence H, Schulkin J (2011) Obstetrician-gynecologists and women’s mental health: findings of the collaborative ambulatory research network 2005–2009. Obstet Gynecol Surv 66(5):316–323
McAllister-Williams RH, Baldwin DS, Cantwell R, Easter A, Gilvarry E, Glover V, Khalifeh H (2017) British Association for Psychopharmacology consensus guidance on the use of psychotropic medication preconception, in pregnancy and postpartum 2017. J Psychopharmacol 31(5):519–552
Melville JL, Reed SD, Russo J et al (2014) Improving care for depression in obstetrics and gynecology: a randomized controlled trial. Obstet Gynecol 123(6):1237
Morgan MA, Cragan JD, Goldenberg RL, Rasmussen SA, Schulkin J (2010) Obstetrician-gynaecologist knowledge of and access to information about the risks of medication use during pregnancy. J Matern Fetal Neonatal Med 23(10):1143–1150
Patel BN, Beste J, Blackwell J (2011) Antidepressant use during pregnancy. Clin Inq 83(10):1213–1215
Payne JL (2017) Psychopharmacology in pregnancy and breastfeeding. Psychiatr Clin N Am 40(2):217–238
Payne JL, Meltzer-Brody S (2009) Antidepressant use during pregnancy: current controversies and treatment strategies. Clin Obstet Gynecol 52(3):469–482
Reefhuis J, Devine O, Friedman JM, Louik C, Honein MA (2015) Specific SSRIs and birth defects: Bayesian analysis to interpret new data in the context of previous reports. BMJ 351:1–8
Robertson E, Grace S, Wallington T, Stewart DE (2004) Antenatal risk factors for postpartum depression: a synthesis of recent literature. Gen Hosp Psychiatry 26(4):289–295
Schmidt LA, Greenberg BD, Holzman GB, Schulkin J (1997) Treatment of depression by obstetrician-gynecologists: a survey study. Obstet Gynecol 90(2):296–300
Siu AL, Bibbins-Domingo K, Grossman DC et al (2016) Screening for depression in adults: US preventive services task force recommendation statement. JAMA 315(4):380–387
Stuart S, Koleva H (2014) Psychological treatments for perinatal depression. Best Pract Res Clin Obstet Gynaecol 28(1):61–70
US Food and Drug Administration (2012) FDA drug safety communication: selective serotonin reuptake inhibitor (SSRI) antidepressant use during pregnancy and reports of a rare heart and lung condition in newborn babies. http://www.fda.gov/Drugs/DrugSafety/ucm283375.htm
Vitale SG, Laganà AS, Muscatello MRA, La Rosa VL, Currò V, Pandolfo G et al (2016) Psychopharmacotherapy in pregnancy and breastfeeding. Obstet Gynecol Surv 71(12):721–733
Yonkers KA, Wisner KL, Stewart DE et al (2009) The management of depression during pregnancy: a report from the American Psychiatric Association and the American College of Obstetricians and Gynecologists. Gen Hosp Psychiatry 31(5):403–413
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This study was funded by the Maternal and Child Health Bureau (Title V, Social Security Act), Health Resources and Services Administration, and Department of Health and Human Services (HHS) via grant number R60MC 05674. The funding source had no role in the study design; collection, analysis, or interpretation of data; nor the drafting of this manuscript.
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Taouk, L.H., Matteson, K.A., Stark, L.M. et al. Prenatal depression screening and antidepressant prescription: obstetrician-gynecologists’ practices, opinions, and interpretation of evidence. Arch Womens Ment Health 21, 85–91 (2018). https://doi.org/10.1007/s00737-017-0760-7
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DOI: https://doi.org/10.1007/s00737-017-0760-7