Treatment Initiation for New Episodes of Depression in Pregnant Women

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PROJECT SUMMARY Up to 12% of pregnant women have a new episode of depression, ie, an incident or recurrent depressive episode with symptom onset during pregnancy. Effects of untreated antenatal depression include unhealthy maternal behaviors (eg, diminished self-care, smoking, substance use, self-harm) and emotional and behavioral problems in offspring. Antenatal depression or elevated depression scores, identified by screening instruments, increase the risk of preterm birth (PTB), low birth weight (LBW), and small for gestational age (SGA) birth, and are associated with breastfeeding discontinuation before 3 months postpartum. In-person psychotherapy and antidepressant medication improve depression symptoms in many with depression, yet <50% of pregnant women with new episodes of depression initiate these treatments. Although some barriers to initiating antidepressants and psychotherapy are known, other factors have not been well described, especially after accounting for depression severity. Furthermore, the impact of antidepressants and psychotherapy on perinatal outcomes, including PTB, LBW, SGA, and breastfeeding continuation among pregnant women with new episodes of depression after accounting for confounding by depression severity is unknown. Given the importance of factors influencing the decision to initiate antidepressant or psychotherapy treatment during pregnancy and the need for further evidence on the perinatal risks and benefits associated with antidepressant use and psychotherapy in pregnant women, the goal of this study is to identify predictors and perinatal effects of psychotherapy and antidepressant use for new episodes of depression during pregnancy while accounting for depression severity. We will conduct this study in a racially and ethnically diverse multi- site population using electronic health data, enriched with survey data from a subset of women. Among pregnant women with new episodes of depression, we will evaluate factors that influence the propensity to initiate psychotherapy or antidepressants; accounting for these is crucial when studying treatment effects. We will describe patterns of use of alternative depression management approaches (eg, Internet- based psychotherapy, peer support groups, and complementary and alternative medicine) and will evaluate whether initiation of psychotherapy or antidepressants is associated with these practices while accounting for depression severity. We will quantify the impact of psychotherapy and antidepressants (including dose, timing, and duration of use) on PTB, LBW, SGA, and breastfeeding continuation accounting for the propensity to initiate psychotherapy or antidepressants and depression severity. We are uniquely positioned to overcome limitations of confounding and small size in prior studies given our data on depression severity and maternal comorbidity for more than 8,000 pregnant women. Our study will be informative for understanding the mental health interventions utilized by pregnant women with depression and will inform decision making on optimal depression management during pregnancy.