Assessing low mood during pregnancy

Behavioural outcomes of children exposed to antidepressants and unmedicated depression during pregnancy

BACKGROUND

Antenatal exposure to both antidepressants and maternal depression has been associated with child behavioural difficulties. However, previous research has not adequately distinguished between the effects of the antidepressants and the underlying maternal depression.

METHODS

Child behavioural difficulties were assessed using the Strengths and Difficulties Questionnaire at 2-, 4.5-, and 8-years of age by mothers in the Growing Up in New Zealand study (N = 6233 at 2-years; N = 6066 at 4.5-years; N = 4632 at 8-years). Mothers were classified as either on antidepressants, unmedicated depression, or neither based on self-reported antidepressant intake during pregnancy and the Edinburgh Postnatal Depression Scale. Hierarchical multiple logistic regressions were used to examine whether antenatal exposure to antidepressants and unmedicated depression had a differential association with child behavioural outcomes relative to no exposure.

RESULTS

When later life depression in the mother and a range of birth and sociodemographic variables were accounted for, neither antenatal exposure to unmedicated depression or antidepressants remained associated with an increased risk of behavioural difficulties at the ages investigated. However, maternal later life depression was associated with behavioural difficulties in the fully adjusted analyses at all three ages investigated.

LIMITATIONS

The current study relied on mother-report of child behaviour which may be susceptible to bias due to maternal mental health problems.

CONCLUSIONS

Adjusted results did not show an adverse association between antenatal antidepressant exposure or unmedicated depression in relation to child behaviour. Findings also suggest that efforts to improve child behaviour need to include more family-based approaches that support maternal wellbeing.

Prevalence of antidepressant use and unmedicated depression in pregnant New Zealand women

BACKGROUND

Throughout pregnancy, women are at an increased risk of depression, with prevalence estimates between 6.5% and 18%. Global prevalence of antenatal antidepressant use is considerably lower at 3%.

OBJECTIVE

The present study determined the proportion of women taking antidepressants across pregnancy in New Zealand. We investigated whether variation exists across age bands, area-level deprivation and ethnicities, and identified how many women experienced unmedicated depression.

METHOD

Antenatal data (n = 6822) consisted of primarily third-trimester interviews conducted with mothers participating in Growing Up in New Zealand, a longitudinal study investigating child development. Women were asked about their antidepressant intake during pregnancy and assessed on antenatal depression symptoms using the Edinburgh Postnatal Depression Scale. Antidepressant use data were also compared to population-level data from Statistics New Zealand's Integrated Data Infrastructure.

RESULTS

Antidepressant prevalence across pregnancy was 3.2%, with a 2.7% prevalence in trimester one and 2.6% following the first trimester. There was no significant difference in usage within age bands and area-level deprivation quintiles. Ethnicity-specific data revealed that Pasifika and Asian ethnicities had the lowest antidepressant use, and New Zealand Europeans the highest. The rate of unmedicated depression, where women met the Edinburgh Postnatal Depression Scale criteria for significant depressive symptoms but did not receive antidepressants during pregnancy, was 11.8%, indicating that antenatal depression treatment may be inadequate. Greater rates of unmedicated depression were seen for younger women (⩽24 years), those living in high deprivation areas and mothers of Pasifika, Asian and Māori ethnicities.

CONCLUSIONS

Antenatal antidepressant use in New Zealand follows global prevalence estimates and highlights possible undertreatment of antenatal depression in New Zealand. Future research including other treatment types (e.g. behavioural therapy) is needed to evaluate whether undertreatment occurs across all treatment options.