Prescribing antidepressants and anxiolytic medications to pregnant women: Comparing perception of risk of foetal teratogenicity between Australian Obstetricians and Gynaecologists, Speciality trainees and upskilled General Practitioners

Abstract

Background: The decision of whether to prescribe antidepressants (AD) and anxiolytics (AX) to pregnant women is complex, with serious potential ramifications. Clinicians’ perception of the risk of teratogenicity significantly influences their prescribing decisions and in turn impacts maternal decision making. Our cross-sectional study sought to discern differences in perceived risk between Obstetricians and Gynaecologists (O&Gs) and General Practitioners (GPs) when prescribing these medications in pregnancy. Furthermore, we investigated factors impacting perception, clinicians’ willingness to prescribe and their approach to provision of patient information. Methods: This cross-sectional study was conducted via a nation-wide online SurveyMonkey extended to Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) database-derived affiliates: GP diplomates, fellows and trainees (5409 survey invitations: 545 respondents). O&Gs and GPs were compared using Pearson Chi-squared test for categorical variables and the Student t-test for continuous variables. Results: GPs reported higher rates of being aware of up-to-date medication prescription recommendations (57.6%) compared with O&Gs (44.2%). GPs also reported higher rates of training adequacy in psychotropic prescription (56.1% versus 29.0%). There was evidence to suggest GPs level of confidence in knowledge base, initiation and prescription of AD and AX was higher than those of O&Gs. The mean perception of patient non-compliance was similar between clinician groups (approximately 35%), but GPs perceived the extent of patient anxiety as higher compared to O&Gs (mean 73.7% (SD 21.3) versus 63.1% (SD 24.1), p<0.001). Both groups showed a strong preference for improved training rather than patient-focused technology (above 70% for both groups). Conclusion: Further development of clinician training in perinatal psychotropic prescription is warranted.

Antidepressant use During Pregnancy: Knowledge, Attitudes, and Decision‐Making of Patients and Providers

“…Of the 19 studies, 4 were defined by their authors as qualitative, 7 were mixed‐methods, and the remaining 8 used quantitative methodologies. The majority of studies relied on study‐specific surveys or questionnaires designed by the authors 22,29–42 . Focus groups were used in one study, 43 and in‐depth semistructured interviews were used in 4 studies 20,22,41,44 …”

“…Many physicians described psychopharmacology as more harmful than other classes of medications 33 . For instance, general practitioners in Denmark overestimated the risk of psychopharmacology, whereas general practitioners and obstetrician‐gynecologists in the same sample underestimated the risk of other medications 29 . See Table 2 for greater detail regarding provider knowledge of teratogenic risk.…”

“…Among providers, 33.3% to 78.1% of physicians reported some level of confidence in advising patients about antidepressant use during pregnancy 29,30,32,36,38 . Levels of comfort and confidence were related to beliefs about the relative safety of antidepressants.…”

“…Those that reported more comfort prescribing SSRIs were more likely to agree that the risks of untreated depression outweigh risk of medications 30 . Although comfort or low levels of concern with prescribing to pregnant patients were reported by many providers, fewer expressed confidence in their own ability to prescribe antidepressants during pregnancy 29,38 …”

“…Health care provider education, training, and engagement with the treatment of depression and anxiety during pregnancy, including the use of antidepressants, were assessed in 5 studies 29,32,33,37,43 . Up to 71% of psychiatrists sampled reported some education about psychopharmacology in pregnancy during their training, 37 and between 29% and 56.1% of providers reported they had adequate training related to antidepressant use during pregnancy 29 .…”