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 Depression and anxiety are common disorders, however their occurrence during pregnancy has the potential to significantly impact the health and wellbeing of both mother and child [1, 2]. Negative outcomes of mental health disorders in pregnancy include a variety of serious complications. Inadequately treated depression is associated with a substantial risk of maternal, fetal and neonatal morbidity and mortality [3]. In addition to subjective distress, the impact on relationships can be very significant, particularly when attachment to the newborn is disrupted. This may lead to enduring detrimental effects on the child extending into adulthood [4]. Depression also leads to suicide, with it being the second largest cause of indirect maternal mortality in the perinatal period in Australian women [1]. Unclear messages contribute to pregnant women being reluctant to take psychotropic medication, including antidepressants and anxiolytics with many fearing foetal harm [5-8]. Medical personnel including O&Gs and GPs form an important part of a pregnant woman's network of information sources during pregnancy and can impact patient decision-making around medications in pregnancy [7-9]. The Australian clinicians' own

“There is always a waitlist”: The experiences of perinatal women randomized to a waitlist condition in a trial evaluating a novel online self-directed intervention for perinatal anxiety

“…According to Jorm (56), the term mental health literacy is used to describe the level of public knowledge regarding mental disorders. The broader literature supports that lower mental health literacy, specifically around perinatal mental health concerns, amongst healthcare providers and perinatal individuals may impair perinatal individuals' ability to access supports for perinatal anxiety (23,36,57,58). For example, perinatal participants in a qualitative study by Harrison et al ( 23) expressed difficulty identifying their symptoms of perinatal anxiety, which impeded their ability to seek supports.…”

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

“…General practitioners in Australia anticipated more anxiety about the use of antidepressants and predicted higher rates of nonadherence with medication because of patient concerns more often than obstetrician-gynecologists from the same study. 29 Providers appeared to put more emphasis on social stigma during decision-making than patients themselves. 34 Two studies inquired about legal liability and found that 22% of psychiatrists 37 and 55% of general practitioners indicated that liability concerns impacted their decision-making.…”

“…Patients were recruited during clinic visits, 22,[39][40][41][42]44 from a parent study, 42 through media and advertising, 34 or through an online survey platform. 45 Health care providers were recruited through specific health care systems, 33,34,38,43 listservs, 29,32 professional membership, 30 training workshop, 36 catchment area, 35 or national 31 or regional directories. 31,36,37 Only one study used classic random sampling 30 and 2 used random sampling in combination with alternative strategies.…”

“…20 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. Providers that prescribed antidepressants and those reporting more comfort with prescribing SSRIs were more likely to agree that SSRIs are not associated with increased risk and are relatively safe for use in pregnancy.…”

How do prenatal people describe their experiences with anxiety? a qualitative analysis of blog content

“…Until recently, there has been a lack of discourse around prenatal anxiety in society and the literature [ 9 , 11 , 20 ], which has perpetuated several of the help-seeking barriers faced by prenatal people experiencing anxiety. Limited knowledge among the general public and healthcare providers about symptoms of perinatal anxiety and treatment options, which constitutes a key component of mental health literacy, can hinder pregnant and postpartum people’s help-seeking endeavours [ 2 , 21 – 24 ]. Research by Ponzini et al [ 21 ] suggests that there is a lack of clarity around symptoms of postpartum anxiety disorders, with perinatal people exhibiting greater familiarity with symptoms associated with postpartum depression.…”