197032 Women's decisionmaking around the use of antidepressant medications during pregnancy

Tuesday, November 10, 2009

Andrea Lynn Kalfoglou, PhD , Health Administration and Policy Program, University of Maryland, Baltimore County (UMBC), Baltimore, MD
Between 8-20 percent of pregnant women experience clinical depression. The majority is sub-optimally treated or untreated. Women who discontinue taking antidepressants at conception are at tremendous risk of relapse (68%), and inadequate treatment of depression during pregnancy contributes to maternal suicide, reduced use of prenatal care, substance abuse, self neglect, and premature infants. The National Institute of Mental Health has identified health services research around maternal depression as a priority area for research. Anecdotal evidence suggests that many pregnant women discontinuing antidepressant therapy out of fears about risks to the fetus that are, in fact, unfounded, and the misperception that pregnancy is a time of emotional wellbeing, conferring “protection” against psychiatric disorders. A major obstacle to providing optimal treatment and counseling of depressed, pregnant women is that data are lacking on the reasons why women discontinue their antidepressants. We conducted a pilot qualitative interview study with a convenience sample of 25 women who were taking antidepressants prior to planning or initiating a pregnancy. The vast majority of women chose to discontinue medication, and a majority of these women experience some level of relapse but felt they had to suffer in order to protect their fetus. Beliefs about the risks of antidepressants appear to be grounded in cultural expectations that women will keep their bodies “clean” during pregnancy. Further research needs to explore whether and how women can absorb new messages that a woman's mental health is just as important to her growing fetus as her physical health.

Learning Objectives:
Participants will be able to: 1) describe the scope of the problem of perinatal depression 2) Identify some of the reasons women have given for discontinuing or continuing to take antidepressant medication during pregnancy 3) Identify the influences on a pregnant woman's decisionmaking 4) Evaluate current clinical practice around advising pregnant women taking antidepressant medications

Keywords: Maternal Health, Depression

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the primary investigator of the study
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.