(102) Evaluating Patterns and Potential Benefits of Antidepressant Initiation Before vs. at Delivery

Perinatal depression is a common complication that often worsens following delivery. Typical management involves initiating treatment with onset of symptoms though some patients may be hesitant to take medication during pregnancy. This study investigates whether initiating treatment before delivery is associated with improved depression symptoms postpartum compared to initiating during the delivery admission.

Study Design:

This retrospective cohort included all deliveries of patients who were not prescribed antidepressants or anxiolytics at the initial prenatal visit but later initiated treatment during pregnancy or at delivery, and who delivered in a single health system from 1/1/2021-6/30/2025. The primary exposure was psychotropic medication prescription at the time of the last prenatal visit prior to delivery and the comparison group initiated medication at postpartum discharge. Patient characteristics and clinical outcomes were compared in bivariate analysis. Multivariable logistic regression with propensity scoring evaluated odds of elevated initial postnatal EPDS score >10  as well as secondary outcomes (42-day readmission, postpartum visits within 8 weeks).

Results:

Among 5,198 patients, 78.2% (N=4,065) initiated medication prior to delivery. Patients who started medication at delivery admission were younger, had lower BMI, and initiated prenatal care later (Table 1). They also had higher rates of preterm birth, longer postpartum stay, and higher incidence of SMM and ICU admission. Elevated EPDS scores were observed in 10.5% (N=426) of patients who started treatment pre-delivery, compared to 7.1% (N=81) at delivery (p < 0.01). Multivariable analysis demonstrated aOR of 0.97 for elevated EPDS scores with initiation of treatment at delivery (95% CI 0.79–1.19) and 1.21 (95% CI 1.06-1.39) for short-term postpartum follow-up.

Conclusion:
These data did not demonstrate measurable differences in depression symptoms based on timing of medication initiation, though initiation at delivery was associated with deliveries complicated by SMM and with higher odds of short term postpartum follow up.