OBJECTIVES: Poor depression management has been associated with adverse pregnancy outcomes, such as preterm birth and low birth weight. Due to the broad exclusion of pregnant patients from clinical trials, limited evidence exists on the efficacy of antidepressant treatments (ADTs) during pregnancy. This study aimed to describe patient characteristics and depression severity among women with major depressive disorder (MDD) or anxiety by ADT use during pregnancy.

METHODS: This real-world study used claims data from Komodo Research Dataset linked to EHR-derived data from Komodo Clinical Observations between 01/01/2016–08/30/2023 to identify females with both a gestational age and a known end of pregnancy event (i.e., live birth, miscarriage, etc.) claims. Patients were required to have an anxiety or MDD diagnosis and ≥1 ADT claim during the year prior to derived pregnancy start. Depression severity was measured using patient health questionnaire-9 (PHQ-9) scores during the 365 days before (baseline) and after (follow-up) pregnancy start.

RESULTS: 1,215 pregnant patients were included in the analyses (mean age: 30.0 years); 27.2% of patients maintained their baseline ADT throughout pregnancy whereas 72.8% discontinued before the end of pregnancy. Medicaid enrollment upon pregnancy start was more common among patients who discontinued vs. maintained their ADT (46.7% vs. 22.1%). In baseline, 42.9% vs. 54.5% of patients that maintained vs. discontinued ADT use had moderate to severe depression (PHQ-9 score ≥10), respectively; during follow-up, the proportions were 30.8% vs. 39.4%.

CONCLUSIONS: Depression severity was lower both before and after pregnancy start for patients who maintained ADT use than those who discontinued. While patients who discontinued ADT experienced a larger decrease in depression severity than patients who maintained, both cohorts experienced decreases during follow-up. Additional research should be conducted to identify factors driving these differences and the overall decrease among patients who discontinued.