(400) Characteristics of Psychotropic Medication Prescribing Before, During, and After Pregnancy

Mental health conditions like depression and anxiety are common in reproductive age individuals, yet antidepressants and anxiolytics are often discontinued in pregnancy. This study evaluates trends in these prescriptions before and throughout pregnancy.

Study Design:

This is a retrospective cohort study of individuals who delivered in a single health system from 1/1/2021-6/30/2025. Prescriptions were evaluated at 4 time points: 6 months prior to delivery, the initial prenatal visit, 32 weeks gestation, and discharge from delivery admission. The frequency of antidepressant and anxiolytic prescriptions at each time point was compared between individuals who were prescribed these medications prior to pregnancy and those who initiated them during pregnancy. Characteristics of individuals who continuously prescribed psychotropic medications were compared to those who initiated medication during pregnancy at any time point in bivariate analyses.

Results:

Among 52,778 individuals, 6,421 (12.2%) had an antidepressant or anxiolytic prescription in the 6 months before pregnancy. Of these, 1,499 (23.3%) continued their prescriptions throughout pregnancy and at discharge. There were 5,048 (9.6%) individuals that were initiated on medication during or immediately postpartum [Figure]. Those with continuous prescriptions were older, had higher pre gravid and delivery BMI, and were less like likely to be Black or Hispanic. They were also less likely to have Medicaid insurance, more likely to be multiparous and initiate prenatal care earlier [Table]. Preterm birth rates did not differ between groups; however, individuals with continuous prescription use had a higher rate of NICU admission (12.2% vs. 8.4%, p < 0.01).

Conclusion:

Affective disorders are a major comorbidity in pregnancy, with a large number of individuals taking psychotropic medication during this time. Understanding prescribing patterns and identifying disparities related to social determinants of health can inform strategies to optimize perinatal mental health care.