The report in the Archives of Women’s Mental Health suggested that awareness of alternative therapies would be valuable.
A study led by the Baylor College of Medicine in Houston pointed out that female U.S. veterans have higher rates of MH disorders compared with civilian females in the U.S. That puts these women at risk for poor MH outcomes during pregnancy.
The researchers sought to evaluate the MH burden and identify the prevalence of antidepressant prescription and discontinuation among pregnant veterans (PGVets).
To do that, they retrospectively reviewed the electronic health records (EHR) over a 2-year period of PGVets using Veteran Affairs (VA) maternity care benefits. The study included 351 female veterans who had a current MH diagnosis of depression, anxiety, or posttraumatic stress disorder (PTSD) at the onset of pregnancy.
The study team was focused on outcomes and included information about antidepressant use prior to pregnancy, the use and discontinuation of antidepressants during pregnancy, and risk factors for discontinuation.
The results indicated that PGVets had a high MH burden, with 67% of the sample having multiple comorbid diagnoses of unipolar depression, anxiety, and PTSD. At the onset of pregnancy, 163 (46%) were treated with an antidepressant, the researchers explained, but only 56 (34%) continued using antidepressants through the pregnancy.
Both self-discontinuation (34%) and VA provider discontinuation (31%) of antidepressants occurred, according to the authors.
“Among PGVets with documented past suicidal behaviors, 90% discontinued their active antidepressants. PGVets with indicators for more severe MH diagnoses were most likely to discontinue,” the study advised.
A study earlier this year published in the Journal of Maternal-Fetal & Neonatal Medicine looked at the continuation of antidepressants during pregnancy in the U.S. overall. The researchers from the Columbia University Irving Medical Center in New York and the University of California in San Francisco used a large administrative database to determine whether psychiatric medications are continued during pregnancy and predictors of continued medication treatment.
The study team determined that of approximately 2.7 million women included in the analysis, 86,454 (3.1%) filled a prepregnancy prescription for an anxiolytic or antidepressant medication within 3 months of estimated conception.
Of the women who filled a prepregnancy prescription, researchers reported that 49.4%, 26.1%, and 20.1% filled subsequent prescriptions in the first, second, and third trimesters, respectively. “Discontinuation rates ranged by pharmaceutical agent, from 16% for fluoxetine to 71% for alprazolam,” the study noted. “White women and women over 25 were more likely to continue anxiolytic and antidepressant treatment during pregnancy.”
The authors concluded, “Because untreated and under-treated mental health conditions are linked to adverse maternal outcomes, high discontinuation rates may have important implications for maternal health.”
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