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RESEARCH TRIANGLE PARK, N.C. –Untreated serious mental health problems during and after pregnancy could potentially cause more harms than risks of continuing to take medications to treat the conditions, according to a new evidence review published in the journal Psychiatric Research & Clinical Practice. The findings were produced by RTI International (RTI), a nonprofit research institute, under a contract from the Agency for Healthcare Research and Quality (AHRQ).
“After reviewing several studies related to mental health treatments during and after pregnancy, we found that there is an absence in high quality research – what we mean by this is that the majority of the studies couldn’t separate the effects of medication compared to the effects of an untreated mental health disorder,” said Meera Viswanathan, PhD, Director of the AHRQ Evidence-based Practice Center at RTI – University of North Carolina and lead author on the publication. “This shows that it is really not clear if mental health related drugs cause harms to pregnant or postpartum women, or if harms are caused by mental health disorders in themselves.”
The researchers reviewed 164 studies on pregnant, postpartum, or reproductive-age women with mental health disorders treated through pharmacotherapy. The results indicated that brexanolone and sertraline – medications used to treat mental health disorders – likely lessen depressive symptoms and mood stabilizers may reduce the recurrence of bipolar disorder for women who are pregnant or have recently given birth. The evidence for other drugs was sparse or unavailable.
Although many of the studies reviewed reported on adverse events, the majority of the evidence for most drugs was not sufficient to ascertain harms, including for birth defects. For a minority of outcomes, studies reported harms, but underlying mental health disorders as the cause of the association between exposures to treatments and the impact of the drugs could not be ruled out. The researchers say that the lack of clear evidence does not mean that medications for mental health treatments should not be used as treatment options during and post pregnancy.
“Even though we reviewed many studies, the lack of high-quality evidence means that many questions remained unanswered," said Viswanathan. “Women who are thinking about starting, stopping, or continuing the use of mental health medications during pregnancy should have a conversation with their doctors. It’s critical that patients and providers are able to make informed decisions and our study shows a need for more and higher quality research.”
To read the full study: https://onlinelibrary.wiley.com/doi/full/10.1176/appi.prcp.20210001
