Maternal education significantly and positively linked with prenatal continuation of antidepressants

"Pregnant women having lower levels of education or high school discontinue their antidepressant medication more frequently compared to those with more years of education," the researchers reported.

Ketevan Marr and researchers from France suggest that perinatal healthcare providers should be aware that educational level may impact antidepressant intake decision-making.

Prenatal depression is increasingly recognized as the most common morbidity in pregnancy. Its global pooled prevalence rate is estimated to be 15% and is associated with sustained poor maternal mental health in the postpartum period, and a variety of adverse short- and long-term outcomes in children.

Antidepressants are sometimes recommended for severe symptoms. Social determinants are often linked with antidepressant use in the general population, and it is unknown if this is the case for pregnant populations.

According to the study authors, no previous reviews have been conducted examining the relationship between prenatal antidepressant use and continuation and social determination. Therefore, Dr. Marr and colleagues aimed to evaluate these associations through a systematic review of the literature and meta-analyses. They provided pooled association measures between prenatal antidepressant intake and various social determinants (SD).

The researchers conducted a systematic search of five databases to identify publications from inception to October 2022 that reported associations with prenatal antidepressant intake (continuation/use) and one or more social determinants: race, education, relationship, immigration status, employment, or income. Eligible studies were included in random effects meta-analyses.

The researchers reported the following findings:

• 23 articles describing 22 studies were included. Education was significantly and positively associated with prenatal antidepressant continuation and heterogeneity was moderate. (Odds ratio = 0.83).
• Meta-analyses of antidepressant use and education, race, relationship status, and antidepressant continuation and income were not significant with high levels of heterogeneity.

"While most social determinants in the review were not linked with prenatal antidepressant intake, lower maternal education levels do seem to be linked with lower rates of prenatal antidepressant continuation," the researchers wrote. "Education appears to be linked with intake of prenatal antidepressants."

"Continued investigation into social determinants remains a research venue to disentangle the complex web of how SD and other decision-making factors interrelate during this crucial time for both expectant mothers and their offspring," they concluded.

Reference:

Marr, K., Maguet, C., Scarlett, H., Dray-Spira, R., Dubertret, C., Gressier, F., Sutter-Dallay, L., & Melchior, M. Social determinants in prenatal antidepressant use and continuation: Systematic review and meta-analysis. Acta Psychiatrica Scandinavica. https://doi.org/10.1111/acps.13647