| Description |
- Background: High-risk pregnancies are associated with a higher risk of antenatal and postpartum depression. ACOG recommends early perinatal depression screening, and SSRIs as first-line pharmacotherapy with follow-up using validated screening tools. Without supportive systems in place, high quality behavioral health care is difficult to achieve in high-risk obstetrics clinics. To characterize depression screening and management in high-risk pregnancies.
Methods: This retrospective cohort study evaluated pregnancy episodes from a single high-risk obstetrics center at an academic institution between January 2021 and December 2023. 5313 patients met criteria for delivery and prenatal visits; 1421 patients had any PHQ-9 screen during pregnancy; there were 74 patients who had positive screenings (≥10) for a total of 76 unique pregnancy episodes. (2 patients had 2 separate pregnancies meeting criteria in this timeframe). Descriptive statistics were performed for pregnancy episodes.
Results: Of 76 pregnancy episodes, the study identified a high prevalence of pre-existing mental health diagnoses (n=62, 81.6%) and history of pregnancy-related mood disorder (n=21, 27.6%). Most initial screenings were in the first trimester (n=62, 81.6%). Interventions during pregnancy were provided for 65.8% of patients (n=50). SSRIs were started by OB in 11 (14.5%) pregnancies; while all patients received general follow-up care, about over half did not have a validated screening before starting medication (n=6, 54.5%) or during follow-up (n=10, 90.9%).
Conclusion: Current practice suggests gaps in utilization of validated screening tools to identify and manage depression during pregnancy. Collaborative care, an existing behavioral health integration model, should be considered as a solution in outpatient high-risk obstetrics.
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