Abstract
Objective To determine independent perinatal associations of anxiety and depression in women
who were and were not treated with psychotropic drugs in comparison to unaffected
pregnancies.
Study Design From 2013 to 2014, 978 (6.3%) cases of anxiety/depression, of which 35% used psychotropic
drugs, were compared with 14,514 (93.7%) unaffected pregnancies using logistic regression.
Results Subjects were more likely to be Non-Hispanic Whites, use tobacco and illegal substances,
be unmarried, use public insurance, and have medical complications of pregnancy. For
independent maternal outcomes, untreated anxiety/depression was associated with labor
induction (adjusted odds ratio [aOR] = 2.02), cesarean deliveries (aOR = 1.69), longer
length of stay (aOR = 1.96), readmission (aOR = 2.40), fever (aOR = 2.03), magnesium
exposure (aOR = 1.82), and postpartum hemorrhage (aOR = 2.57), whereas treated cases
were associated with increased blood transfusion (aOR = 4.81), severe perineal lacerations
(aOR = 2.93), and postpartum hemorrhage (aOR = 3.85), but decreased risk of cesarean
deliveries (aOR = 0.59). Independent neonatal outcomes included small for gestational
age (aOR = 3.04), meconium-stained fluid (aOR = 1.85; 2.61), respiratory failure (aOR = 5.84),
neonatal adaptation syndrome (aOR = 11; 10.2), and neonatal seizures (aOR = 12.3)
in treated cases, whereas untreated cases were associated with hypoxia (aOR = 2.83),
low Apgar score (aOR = 3.82), and encephalopathy (aOR = 18.3). Exposure to multiple
psychotropic medications independently increased the risk of neonatal adaptation syndrome,
neonatal length of stay, and hypoglycemia.
Conclusion Untreated cases were associated with increased maternal adverse outcomes, whereas
treated cases were associated with more adverse neonatal outcomes when compared with
unaffected pregnancies.
Keywords
anxiety - depression - psychotropic medication - maternal outcome - neonatal outcome
- neonatal adaptation syndrome
