(1141) Clinician Perspectives on Antidepressant Use in Pregnancy: Unpacking Barriers and Racial Disparities in Medication Continuation

Untreated maternal depression leads to significant maternal morbidity/mortality, yet more than half of patients stop antidepressants in pregnancy. Patients of color are less likely to continue medications compared to white patients. Our objective was to evaluate clinician perceptions on antidepressant use in pregnancy, with an equity focus.

Study Design:

This two-site, mixed-methods (quant- >QUAL) study included providers of perinatal and mental health care from 2-5/2025. All clinicians completed the Acceptability of Intervention Measure (AIM) to evaluate acceptability of patients continuing antidepressants during pregnancy (Likert; range 4-20). Clinicians were purposively sampled by specialty/AIM score for individual interviews, which explored barriers/facilitators to antidepressant continuation and its relationship to race/equity. The Consolidated Framework for Implementation Research 2.0 and Health Equity Frameworks were used for coding.

Results:

147 clinicians completed the survey, including 85 (58%) OBGYNs/CNMs, 26 (18%) psychiatrists, 22 (15%) family medicine, and 14 (10%) internal medicine clinicians. Acceptability was high but differed by specialty; IM clinicians had lower AIM vs. others (15.2 ±2.6 vs 17.5 ±2.6, p=0.02). All clinicians reported that patient race did not influence their counseling. In interviews (n=15), facilitators of antidepressant continuation included clinician belief in medication efficacy/safety, risks of discontinuation, and prioritization of mental health. Barriers included lack of time, knowledge gaps on specific medications, and patient preconceived notions (Table 1). Clinicians were not surprised about differences in discontinuation by race, and suggested standardized counseling, culturally sensitive resources, and racially concordant care as tools to improve equity (Table 2).

Conclusion:

This study characterized the acceptability of antidepressant use in pregnancy across clinician specialties. These data, alongside ongoing work on patient perspectives, will inform future equity-focused strategies to promote appropriate continuation of antidepressants in pregnancy.