Does Pharmacologic Treatment of Depression Alter Prenatal Care Compliance in Substance Use Disorder

Objective: To evaluate whether antidepressant utilization alters prenatal compliance in patients with Substance Use Disorder (SUD) enrolled in a multidisciplinary treatment program. Methods: Patients in a cohort study of women enrolled in an SUD program between 2015 and 2022 were eligible. Patients with the co-morbidity of depression at the initial behavioral health assessment were selected. Use of antidepressant medications was recorded at enrollment and during prenatal visits. Prenatal care compliance was the primary outcome. Edinburgh scores and neonatal outcomes were secondary outcomes. Fisher’s Exact test was used in analysis of variables. Results: 240 of 456 (52%) patients had a history of depression. 40 of 240 (17%) were on antidepressants at enrollment versus 7 of 240 (3%) were started on antidepressants during pregnancy. 20 patients on antidepressants out of 47 (61%) having an Edinburgh score ≥12 at enrollment while 54 patients (62%) of the 193 women not treated scored ≥12, P=1.0. SSRIs were the most commonly used drugs (85%). Demographic data was similar between groups. A GAD 7 scores ≥10 was common in patients on medication (47%, n=15), and untreated, (54%, n=61), P=.21. The AAS score was positive for abuse in 27 women on medication (57%) versus 113 (59%) untreated, P=1.0. Patients treated with antidepressants were more commonly on Medication-Assisted Treatment (MAT) at enrollment, 14/47 (32%) vs untreated 23/193 (13%), P=.005. Prenatal visit compliance did not differ between the groups of treated (48% ± 27%) vs untreated (50% ± 28%), P=0.65. Gestational age at delivery, and birthweight did not differ between those treated and not treated with antidepressants. NAS treatment 46% (n=21) vs 44% (n=82), P=.87; and length of hospital stay 14.7 ± 12.0 vs 14.8 ± 20.4, P=.99, were similar. Conclusions: Pregnant patients enrolling in substance use program have a high rate of co-existing depression, anxiety and abuse with a minority of patients on antidepressants despite similar risk profiles. Patients on antidepressants were more commonly on MAT on enrollment. Early treatment was not associated with worsening rates of prenatal care attendance, preterm birth, NAS or neonatal hospitalization. Increased frequency of treatment appears warranted in this population based on elevated Edinburgh scores.