The Contribution of Untreated and Treated Anxiety and Depression to Prenatal, Intrapartum, and Neonatal Outcomes

Abstract

Objective To determine independent perinatal associations of anxiety and depression in women who were and were not treated with psychotropic drugs in comparison to unaffected pregnancies. Study Design From 2013 to 2014, 978 (6.3%) cases of anxiety/depression, of which 35% used psychotropic drugs, were compared with 14,514 (93.7%) unaffected pregnancies using logistic regression. Results Subjects were more likely to be Non-Hispanic Whites, use tobacco and illegal substances, be unmarried, use public insurance, and have medical complications of pregnancy. For independent maternal outcomes, untreated anxiety/depression was associated with labor induction (adjusted odds ratio [aOR] = 2.02), cesarean deliveries (aOR = 1.69), longer length of stay (aOR = 1.96), readmission (aOR = 2.40), fever (aOR = 2.03), magnesium exposure (aOR = 1.82), and postpartum hemorrhage (aOR = 2.57), whereas treated cases were associated with increased blood transfusion (aOR = 4.81), severe perineal lacerations (aOR = 2.93), and postpartum hemorrhage (aOR = 3.85), but decreased risk of cesarean deliveries (aOR = 0.59). Independent neonatal outcomes included small for gestational age (aOR = 3.04), meconium-stained fluid (aOR = 1.85; 2.61), respiratory failure (aOR = 5.84), neonatal adaptation syndrome (aOR = 11; 10.2), and neonatal seizures (aOR = 12.3) in treated cases, whereas untreated cases were associated with hypoxia (aOR = 2.83), low Apgar score (aOR = 3.82), and encephalopathy (aOR = 18.3). Exposure to multiple psychotropic medications independently increased the risk of neonatal adaptation syndrome, neonatal length of stay, and hypoglycemia. Conclusion Untreated cases were associated with increased maternal adverse outcomes, whereas treated cases were associated with more adverse neonatal outcomes when compared with unaffected pregnancies.

SSRI use during pregnancy and risk for postpartum haemorrhage: a national register‐based cohort study in Sweden

“…9 However, the overall PPH prevalence in our study was lower than that reported in other studies, as the registered estimates corresponded to the first 2 hours after delivery and not the first 24 hours postpartum. 10,12,34 The results of this national register-based study are in line with the latest meta-analysis on the topic, with a similar effect size for the reported association (RR 1.32) 35 but a lower one than the ones stated in other epidemiological studies (aOR 1.53-3.85), 10,18,20,34,36 possibly due to the exclusion from our population of pregnancies with inherent bleeding tendency. Another potential explanation for the slightly attenuated association observed could be that in other studies, the SSRI exposure was explored only during late gestation (versus at any time-point), probably including cases with more severe psychiatric illness and with a more amplified dose-response relationship than in our study.…”

Metabolomic Pathways Predicting Labor Dystocia by Maternal Body Mass Index

“…The tryptophan metabolic pathway is important during pregnancy for fetal development, neuronal protection, and serotonin signaling. 71 Serotonin signaling deficiencies may be linked to depression or anxiety in pregnancy, and both maternal trauma history 72 and prenatal depression and anxiety [73][74][75] were associated with labor dysfunction in previous clinical investigations. In addition, serotonin stimulates uterine smooth muscle contractions in pregnant women.…”

Preconception Care in the Veterans Health Administration

“…Depression and PTSD are associated with increased risks of preterm birth, low birth weight, and postpartum depression [57][58][59] and poor infant outcomes such as respiratory failure and low birthweight. [60][61][62] Women with a history of military service are also more likely to experience insufficient sleep compared with non-Veterans, possibly due to increased rates of PTSD or trauma history. 44 Sleep disorders have been linked to perinatal and maternal complications including preterm birth, preeclampsia, and gestational diabetes.…”

“…68 These experiences are also associated with mental health comorbidities including PTSD and depression, which in turn increase risk of adverse pregnancy outcomes. [60][61][62] A high proportion of women Veterans have also experienced sexual assault and trauma during their military service. In the VA health care system, military sexual trauma (MST) is defined as sexual assault or repeated, threatening sexual harassment during military service.…”