New review prioritizes maternal mental health during pregnancy

Treating depression during pregnancy is essential to protecting the health of mothers, babies and families, according to a new review led by Children’s National that calls for a renewed focus on maternal mental health and access to evidence-based care.

The study, published in JAMA Psychiatry, examines the role of selective serotonin reuptake inhibitors (SSRIs) and selective serotonin-norepinephrine inhibitors (SNRIs) in treating major depressive disorder during pregnancy. In the U.S., 5% to 6% of pregnant patients are treated with SSRIs, primarily for major depressive disorder, which affects about 12% of pregnant patients.

Psychiatric conditions are a leading cause of maternal morbidity and mortality. The review emphasizes that major depressive disorder is a complex brain disease shaped by genetic, environmental and epigenetic factors. Untreated, or undertreated, the illness can affect fetal and infant outcomes.

Key findings include:

• SSRIs are an essential component of perinatal mental health care for many patients with major depressive disorder.
• Evidence defining the benefits of SSRI treatment in pregnancy is more limited than evidence describing risks, but several studies show adverse effects when treatment is discontinued in patients with moderate to severe depression.
• Evaluating SSRI safety during pregnancy is challenging because observational studies can be confounded by the underlying illness and related factors.
• When the effects of medication are separated from those of depression and its consequences, accumulated evidence suggests SSRIs carry little or no risk for serious adverse outcomes.
• The field is shifting toward prioritizing treatment of major depressive disorder to optimize maternal health.

“For too long, conversations about depression treatment during pregnancy have focused narrowly on medication exposure, rather than the very real risks of untreated illness,” said Katherine Wisner, MD, MS, associate chief of Perinatal Mental Health at Children’s National and lead author of the study. “Our review reinforces that maternal mental health is central to the health of two generations. Patients deserve balanced, evidence-based guidance that helps them weigh the benefits of treatment alongside potential risks.”

The authors call for coordinated improvements in clinical care and research, including expanded access to maternity, child health and psychiatric services, particularly in communities with limited care options. They also emphasize the importance of structured decision-making that considers the risks of untreated or undertreated illness, the benefits of treatment and the risks associated with SSRI exposure.