Kaiser Permanente study also finds depressive symptoms early in pregnancy predict postpartum depression risk
A new Kaiser Permanente study provides the first evidence that in women with a history of depression, continuing to take an antidepressant medication during pregnancy is tied to a reduced risk of developing postpartum depression.
“It’s difficult to make decisions for yourself and your baby when there is an absence of evidence,” said senior author Samuel J. Ridout, MD, PhD, a psychiatrist with The Permanente Medical Group. “Our study provides the first clear evidence that taking an antidepressant can moderately help prevent postpartum depression. This new information will help pregnant patients discuss with their obstetricians and psychiatrists whether to stay on or to discontinue their antidepressant medication during their pregnancy.”
The study, published in the American Journal of Obstetrics and Gynecology, included 6,552 women age 18 and over who gave birth between 2010 to 2019. All the women included in the study had a depression diagnosis and were on an antidepressant in the year prior to their pregnancy.
The researchers looked at the women’s prescription refill patterns to determine their medication use during pregnancy. They identified 2,216 women who continued their medication; 1,258 who stopped and then restarted their medication; and 3,078 who stopped completely during pregnancy.
Overall, 37.7% or 2,469 women developed postpartum depression. Of these, 761 (34.3%) had continued their medication during pregnancy; 516 (41%) had stopped and then restarted; and 1,192 (38.7%) had fully stopped.
Compared to taking an antidepressant during pregnancy, stopping and then restarting, or fully stopping, was associated with a 14% higher risk of postpartum depression.
The study also found that women with early pregnancy depressive symptoms who stopped taking an antidepressant had a 78% higher risk of postpartum depression and a 272% higher risk of severe postpartum depression, making them 2.5 times more likely to develop postpartum depression than those who stayed on their medication.
Depression screening during pregnancy
Postpartum depression affects 1 in 7 women in the U.S. The American College of Obstetrics and Gynecologists and the American Psychiatric Association recommend depression screening during and after pregnancy along with antidepressant medication prescriptions for some patients.
Kaiser Permanente has made depression screening a routine part of prenatal care, and this study underscores why that screening is so important.
— Kathryn Erickson-Ridout, MD, PhD
Even so, use of antidepressants during pregnancy remains controversial. Some studies have found that some antidepressant medications can have a small effect on a newborn. Yet other studies have shown untreated prenatal depression is associated with preterm birth and stillbirth and poorer infant and child outcomes in the first year of life.
“When a physician is working with a pregnant patient, they are treating two patients at once,” said Ridout. “As a psychiatrist, when I am speaking with a pregnant patient with depression, I present information about risks and benefits as part of a shared decision-making conversation. For the baby, there is nothing bad that will happen if the parent stays on an antidepressant, and it is safe for patients on antidepressants to breastfeed. But there are patients who do not want to take any medication while they are pregnant, and it is important to respect that decision.”
The study also found that depressive symptoms early in pregnancy were associated with at least a 55% higher postpartum depression risk.
“Kaiser Permanente has made depression screening a routine part of prenatal care, and this study underscores why that screening is so important,” said first author Kathryn Erickson-Ridout, MD, PhD, a research scientist at the Kaiser Permanente Division of Research and a practicing TPMG psychiatrist.
Postpartum depression impacts maternal-infant bonding, breastfeeding choices, and infant cognitive and emotional development. The researchers say their study’s findings can help pregnant patients make thoughtful, evidence-based decisions that will benefit themselves, their babies, and their families.
“We know that untreated depression is the largest risk factor for pregnancy-associated suicidal ideation and suicide and that it is a significant risk factor for substance use disorders and related deaths,” said Erickson-Ridout. “We work closely with all pregnant patients who have had a depression diagnosis — whether they stay on or stop their medication — because we want them and their babies to have the best possible outcomes.”
The study was supported by The Permanente Medical Group Biostatistical Consulting Group, the National Institute of Mental Health, and The Permanente Medical Group Physician Researcher Program.
Co-authors include Chethana Eswarappa, MD, and Brooke Harris, PhD, with Kaiser Permanente Northern California; and Lyndsay A. Avalos, PhD, MPH, Mubarika Alavi, MS, and Kelli Peterman, MPH, with the Division of Research.
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About the Kaiser Permanente Division of Research
The Kaiser Permanente Division of Research conducts, publishes, and disseminates epidemiologic and health services research to improve the health and medical care of Kaiser Permanente members and society at large. KPDOR seeks to understand the determinants of illness and well-being and to improve the quality and cost-effectiveness of health care. Currently, DOR’s 720-plus staff, including 73 research and staff scientists, are working on nearly 630 epidemiological and health services research projects. For more information, visit divisionofresearch.kp.org.
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