Major depression goes unnoticed in pregnant women

Healthcare professionals looking after pregnant women should maintain a high level of awareness for the possibility of major depressive disorder (MDD), say US researchers who found the condition frequently goes undetected.

Just 56% of 89 women with MDD had a diagnosis of clinical depression mentioned in their antenatal charts, and just 24% had depression noted on an antenatal chart problem list, report Deirdre Lyell (Lucile S Packard Children's Hospital at Stanford, California) and co-authors.

Depression was noted at intake on 39% of charts, on subsequent clinic visits on 37% of charts overall, and on a problem list in 24% of charts. Depression was noted only once for 20 patients, twice for 12 women, three times for 15 women, and four times for five women. Just one patient had depression noted at all clinic visits.

Analysis showed that antenatal MDD was significantly more likely to be recorded in the medical charts of women who had stopped using antidepressant medications to conceive or participate in a clinical trial than those who had not. Prior use of antidepressants also predicted a record of MDD in antenatal records.

"When identified, MDD should be noted and treated as a medical problem to facilitate communication of this clinically important diagnosis, and enable better surveillance and referral," the researchers recommend.

"Such practices will help alleviate suffering during pregnancy, potentially reduce the risk of obstetric complications associated with depression, and reduce the risk of depression continuing postpartum and depression's associated risks to the infant."

Obstetricians and certified nurse midwives were equally likely to note depression (68 vs 67%), although obstetricians were more likely to note a mental health referral (23 vs 0%), and midwives to note depression on a problem list.

All patients in the current study had a confirmed diagnosis of MDD, defined as a score of at least 14 out of a possible 17 points on the Hamilton Rating Scale for Depression, and were asked to pass a letter to their healthcare provider informing of their participation in a clinical trial testing acupuncture versus massage for antenatal depression.

"While we do not know how many women did so… our results likely overstate the frequency with which prenatal care providers typically identify or acknowledge MDD," Lyell et al comment.

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