Major Depressive Disorder Underdiagnosed in Pregnancy

Major depressive disorder is frequently missed during pregnancy, and under-acknowledged as a problem when it is diagnosed, according to recent research published in the American Journal of Obstetrics & Gynecology.

Deirdre J. Lyell, MD, from the Lucile S Packard Children's Hospital at Stanford, California, and co-authors found that depression is frequently undetected in pregnant women.

Of the 89 women in the study with major depressive disorder (MDD), clinical depression was noted in 56% of antenatal charts and listed in 24% of problem lists.

The investigation showed that prior use of antidepressant medications predicted the notation of MDD in medical charts. Additionally, antenatal MDD was more likely to be noted in the charts of women that had stopped taking antidepressants to conceive or participate in a clinical trial than those who had not.

A diagnosis of depression was noted at intake on 39% of charts. On 37% of charts, depression was noted on subsequent clinic visits and recorded on a problem list in 24% of charts. Only one patient had depression recorded at all clinic visits. Depression was cataloged only once for 20 women, twice for 12 women, three times for 15 women, and four times for five patients.

Depression was noted equally by physicians and certified nurse midwives. The midwives were more likely to add depression to problem lists, while physicians more frequently noted a mental health referral.

The researchers recommended that when MDD is identified, it should be recorded and treated as a medical problem. This enables better surveillance and referral. The researchers add that diagnosing and treating MDD will help alleviate suffering during pregnancy and potentially reduce the risk of obstetric complications associated with depression.