Mood disorders during pregnancy remain underdiagnosed and treated. Both providers and patients have a wide range of beliefs regarding the use of antidepressants during pregnancy, according to findings presented at the American Psychiatric Nurses Association (APNA) 36th Annual Conference held October 19 to 22, 2022, in Long Beach, California. Clinicians overestimated the risks of antidepressants and underestimated the risks of warfarin use in pregnancy, researchers found.
The key clinical implications of the findings are that providers must “remain up to date on emerging clinical research and to anticipate that decision making in this setting may be distressing to many patients and requires adequate time and information provided at each encounter,” said coauthor Rachel Eakley, MSN, RN, PMHNP-BC.
Evidence-based guidelines recommend screening and treating perinatal mood and anxiety disorders, as lack of treatment is associated with adverse outcomes such as prematurity, low birth weight, impaired infant attachment, and postpartum depression. Despite recommendations and potential outcomes, perinatal mood and anxiety disorders are both underrecognized and undertreated.
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To evaluate the perspectives of clinicians and patients about the use of antidepressants during pregnancy, Eakley and coauthor Audrey Lyndon, PhD, RNC, both from the Rory Meyers College of Nursing, performed an integrative review of articles on this topic published between 2011 and 2021.
A total of 19 studies were included. The studies were of quantitative (n=8), mixed-methodology (n=7), and qualitative (n=4) designs, and most (n=15) used a study-specific survey. The studies recruited providers (n=10), patients (n=8), or both (n=1).
Clinicians indicated they had various exposure to and training in the topic and often encountered inaccurate information. Obstetricians and gynecologists cited reluctance of community mental health providers to provide psychopharmacology to pregnant patients as a primary barrier to care.
An inconsistent pattern in prescribing or avoiding medications during pregnancy was found. Providers overestimated the risks of antidepressants and underestimated the risks of warfarin use in pregnancy. Clinicians were more likely to avoid or discontinue antidepressants during pregnancy compared with during lactation. In addition, some providers expressed liability concerns when advising patients about psychopharmacology use during pregnancy.
Overall, clinicians had high rates of confidence in always following evidence-based guidelines about medication use during pregnancy; however, these rates do not match the observed prescribing practices reported by the Centers for Disease Control and Prevention (CDC).
Patients generally preferred using nonpharmacological treatment options during pregnancy and were unsure about how to weigh the risks and benefits of using antidepressants during pregnancy. Patients found decision-making encounters distressing and felt guilty or upset about the negative stigma surrounding antidepressant use in pregnancy.
Patients who chose to discontinue use or declined to initiate use did not consult a different kind of provider or receive more negative information than those who chose to use antidepressants. However, patients in general reported receiving low-quality and confusing or inconsistent information surrounding the topic, feeling unprepared to decide whether or not to use psychopharmacology medications.
The data indicated that more provider education and training are needed to better facilitate the dissemination of accurate information to patients. In pharmacological consultations, patients likely require adequate time for discussions and providers should be aware that some may be reluctant to discuss their concerns due to fear of judgment. Policies about universal screening for mood and anxiety disorders should be implemented to decrease rates of undertreatment.
Future studies investigating the perspective of mental health providers, mental health nurse practitioners, and midwives on antidepressant use during pregnancy are needed as these groups are not represented in the literature, the researchers concluded. They also called for a dyadic study with observation or interview of patient and provider dyads engaged in treatment planning to explore the subjective experience of their shared encounter.
The full results of this integrative review were published in the Journal of Midwifery & Women’s Health.
Reference
Eakley R, Lyndon A. Patient and provider perspectives concerning the use of psychopharmacology during pregnancy: an integrative review. Poster presented at: APNA 36th Annual Conference; October 19-22, 2022; Long Beach, CA.
