The following is a summary of “Comparative Effectiveness of Treating Prenatal Depression with Counseling versus Antidepressants in Relation to Preterm Delivery,” published in the August 2024 issue of Obstetrics and Gynecology by Li et al.

Maternal depression during pregnancy is a common and serious condition that has been linked to an increased risk of preterm delivery (PTD). Despite this association, the relative effectiveness of two prevalent treatment options—mental health counseling and antidepressant use—in mitigating the risk of PTD remains uncertain. While prior research has suggested that antidepressants may be associated with a heightened risk of PTD, there has been a lack of direct comparison between these treatments. This study aims to address this gap by evaluating the comparative effectiveness of mental health counseling versus antidepressants in reducing the risk of PTD associated with maternal depression.

In this large prospective cohort study, researchers analyzed data from 82,170 pregnant women within Kaiser Permanente Northern California (KPNC), an integrated health delivery system. Clinical diagnoses of depression and associated treatments—either antidepressant use or mental health counseling—were extracted from the KPNC electronic health record system (EHR). Gestational age at delivery was also recorded to determine instances of PTD.

Investigators utilized Cox proportional hazards regression and propensity score matching to ensure comparability between treatment cohorts. The findings revealed that untreated depression during pregnancy was associated with a 41% increased risk of PTD (adjusted hazard ratio [aHR]=1.41, 95% CI=1.24-1.60). In contrast, mental health counseling was linked to an 18% reduction in PTD risk compared to untreated depression (aHR=0.82, 95% CI=0.71-0.96). Moreover, a dose-response relationship was observed, with increased counseling visits correlating with greater reductions in PTD risk—up to a 43% reduction with four or more visits (aHR=0.57, 95% CI=0.45-0.73). Conversely, antidepressant use during pregnancy was associated with a 31% increase in PTD risk independent of underlying depression (aHR=1.31, 95% CI=1.06-1.61), and this risk intensified with longer duration of use.

This study offers valuable insights into the comparative effectiveness of mental health counseling versus antidepressants in managing prenatal depression and reducing PTD risk. The results indicate that mental health counseling is more effective in lowering PTD risk, whereas antidepressants may increase this risk. These findings provide critical information for clinicians and pregnant women to make informed, evidence-based decisions regarding treatment options, balancing maternal and fetal health considerations.

Source: sciencedirect.com/science/article/abs/pii/S0002937824009013