Education level is associated with prenatal antidepressant continuation in pregnant women

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1. In this systematic review and meta-analysis, maternal education was significantly and positively associated with prenatal antidepressant continuation.

2. However, other social determinants of health, including race, relationship status, and income, were not significantly associated with prenatal antidepressant use and continuation.

Evidence Rating Level: 1 (Excellent)

Prenatal depression is very common in pregnancy and can be linked to post-partum depression and adverse outcomes in both the mother and child. Pharmacotherapy is often the treatment of choice in those with moderate to severe symptoms of depression. As a result, the use of antidepressants in pregnancy has been on the rise. The social determinants of health are well-studied factors that influence health behaviors and access to various treatments. Prior studies have suggested that pregnant women with certain social determinants, such as low socioeconomic status, are less likely to receive pharmacotherapy for their mood disorders during pregnancy, while other studies have found conflicting results. Given that antidepressant discontinuation during pregnancy can lead to several adverse health outcomes, this study aimed to explore the impact of social determinants on antidepressant use and continuation during pregnancy.

Of 2,176 identified records, 23 studies were included from database inception to October 2022. Studies were included if they measured prenatal antidepressant intake in women who experienced mental health issues, evaluated one or more social determinants, and had a cross-sectional, cohort, or randomized controlled trial design. The review was conducted in accordance with PRISMA guidelines. The study quality was assessed using the Joanna Briggs Institute critical appraisal checklists, and the risk of bias was assessed using the GRADE approach. The primary outcome was the difference between antidepressant use and continuation in the prenatal period based on various social determinants.

The results demonstrated that education was significantly associated with prenatal antidepressant continuation, whereby patients with lower education levels had lower rates of prenatal antidepressant continuation. Although some individual studies found associations between antidepressant use and various social determinants, the results of the meta-analysis found no association between antidepressant continuation and race, relationship status, and income. However, the review was limited by the high heterogeneity of the included studies, which made it difficult to draw conclusions from the findings. Nonetheless, the present study demonstrated that education level may be an influencing factor in prenatal antidepressant continuation.

Click to read the study in Acta Psychiatrica Scandinavica

Image: PD

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