Oral Concurrent Session 1 - Medical and Surgical Complications of Pregnancy
Oral Concurrent Sessions
Kelly B. Zafman, MD, MSCR (she/her/hers)
MFM Fellow
University of Pennsylvania
Philadelphia, Pennsylvania, United States
Yifan Zhu, PhD
Senior Research Scientist
Independence Blue Cross
Philadelphia, Pennsylvania, United States
Sara Kornfield, PhD
Assistant Professor of Psychiatry
Hospital of the University of Pennsylvania
Hospital of the University of Pennsylvania, Pennsylvania, United States
Aaron Smith-McLallen, PhD
Director of Data Science and Health Care
Independence Blue Cross
Philadelphia, Pennsylvania, United States
Sindhu K. Srinivas, MD, MSCE (she/her/hers)
Professor of Obstetrics and Gynecology/Maternal Fetal Medicine
Department of Obstetrics and Gynecology, Perelman School of Medicine, Pregnancy & Perinatal Research Center
Philadelphia, Pennsylvania, United States
Mental health disorders are the largest contributor to maternal mortality, yet there are many pressures to stop antidepressants in pregnancy, including the recent FDA panel. Our objective was to evaluate contemporary patterns and outcomes of antidepressant discontinuation in pregnancy in patients with mental health disorders.
Study Design:
This was a cross-sectional analysis of a state-based private insurance database. Diagnosis Related Groups and ICD-10 codes were used to identify patients who delivered Jan 1st, 2023-Dec 31st, 2024, with a diagnosis of depression/anxiety prior to pregnancy. Patients with an active prescription for a selective serotonin reuptake inhibitor (SSRI) or serotonin norepinephrine reuptake inhibitor (SNRI) 3 months prior to pregnancy were included. Pharmacy claims data was used to ascertain SSRI/SNRI use in pregnancy. Treatment discontinuation was defined as no fills in pregnancy or gap >60 days. We compared differences among patients who continued and discontinued antidepressants.
Results:
Of 3983 patients with depression/anxiety, 1462 (36.7%) entered pregnancy with an active SSRI/SNRI. 260 (17.8%) patients had no medication fills in pregnancy; 945 (64.6%) had a >60-day gap. Similar rates of discontinuation were seen across trimesters, with 29.7%, 31.6%, and 38.6% per trimester. Patients who continued and discontinued antidepressants had similar rates of outpatient and emergency visits for mental health indications prior to pregnancy. However, patients who discontinued medications were more likely to have a mental health emergency during pregnancy with peaks in the 1st (58/1000 vs. 37/1000, p=0.02) and 9th month of pregnancy (59/1000 vs. 29/1000, p< 0.01).
Conclusion:
Treatment for mental health conditions should not be withheld during pregnancy. Despite this recommendation, the majority of patients discontinued SSRI/SNRI therapy which is associated with an almost two-fold higher risk of mental health emergencies. Strategies to promote treatment continuation in pregnancy should be an urgent public health priority as a strategy to mitigate the maternal mortality crisis.