(120) Understanding and addressing antenatal depression management in the high risk obstetrics care setting

Objective: Maternal fetal medicine specialists are uniquely poised to manage mental health in high-risk pregnancies given the compounded effects of depression on maternal and fetal outcomes. However, without supportive systems in place, effective care is difficult to achieve. We characterized depression screening and management practices to inform policy change for perinatal depression care.

Study Design:
Retrospective cohort study evaluating pregnancy episodes from a single academic high-risk obstetrics clinic between 1/2021-12/2023. Primary outcome was percentage of patients screened for depression during pregnancy. Secondary outcomes were frequencies and categories of interventions provided for patients with a positive PHQ-9(≥10) screen. Frequencies and percentages calculated to describe patient characteristics and management for pregnancy episodes. All analyses were performed using IBM SPSS Statistics (Version 27).

Results: 5,313 patients met initial study criteria; only 1,421(26.7%) patients had any PHQ-9 screen during pregnancy; of 1,421, 74(5.2%) patients had positive screenings, for a total of 76 unique pregnancy episodes (Figure 1). Of these 76 episodes, 81.6%(n=62) had a pre-existing mental health diagnosis, including 27.6%(n=21) with a history of pregnancy-related mood disorder (Table 1). Interventions were provided in 65.8%(n=50) of pregnancies. Antidepressants were started in 14.5%(n=11) of pregnancies; of that group, 54.5%(n=6) and 90.9%(n=10) did not have a validated screening completed before starting medication and during follow-up, respectively.

Conclusion: Current practice suggests gaps in utilization of validated screening tools to manage depression during pregnancy, which does not reflect standard of care outlined by the American College of Obstetricians and Gynecologists (ACOG). Our study revealed a concerning low rate of depression screening and suboptimal practices regarding antidepressant use in this high-risk population. An evidence-based collaborative care model has emerged as a potential solution to address gaps and align current practice with ACOG guidelines.