A Prospective Study of Risk Factors for Maternal Depression and Anxiety in Women with Epilepsy During Pregnancy and the Postpartum Period
Abstract number :
2.125
Submission category :
4. Clinical Epilepsy / 4E. Women's Issues
Year :
2021
Submission ID :
1826561
Source :
www.aesnet.org
Presentation date :
12/5/2021 12:00:00 PM
Published date :
Nov 22, 2021, 06:55 AM
Authors :
Page Pennell, MD, FAES - University of Pittsburgh Medical School; Zachary Stowe, MD - Psychiatry - University of Wisconsin; Bettina Knight, RN - Psychiatry - University of Arkansas; Carrie Brown, MS - Emmes Corporation; Elizabeth Gerard, MD - Neurology - Northwestern Medical School; Laura Kalayjian, MD - Neurology - University of Southern California; Patricia Penovich, MD - Minnesota Epilepsy Group; Abigail Matthews, PhD - Emmes Corporation,, Inc.; Kimford Meador, MD - Neurology - Stanford University
Rationale: Pregnancy and postpartum are periods of increased vulnerability to depression, and this risk may be greater in women with epilepsy. Previous studies have shown high rates of postpartum depression (25%-29%) in women with epilepsy. The current study examines the incidence and risk factors for symptoms of depression and anxiety, and major depression diagnosis during pregnancy and postpartum.
Methods: The Maternal Outcomes and Neurodevelopmental Effects of Antiepileptic Drugs (MONEAD) study is a multicenter NIH-funded prospective observational parallel-group cohort study of pregnant women with epilepsy (PWWE; n=331) compared to non-pregnant women with epilepsy (NPWWE; n=102), and healthy pregnant women (HPW; n=102). Lifetime psychiatric diagnoses via the Structured Clinical Interview for Diagnosis (SCID), and symptoms of depression (Beck Depression Inventory (BDI), Edinburg Postnatal Depression Scale (EPDS)) and anxiety (Beck Anxiety Inventory (BAI)) were assessed during pregnancy and through 9 months postpartum in PWWE and HPW, and comparable times for NPWWE. If a participant had scores of BDI > 9 and/or EPDS > 11, a SCID mood module was completed at that visit to assess for diagnosis of a depressive episode.
Results: The overall rates of depressive episodes by SCID criteria were lower than anticipated: PWWE (7.3%); HPW (3.9%); and NPWWE (6.9%), with no difference between PWWE and HPW. However, depressive symptoms and anxiety symptoms were generally higher in PWWE compared to HPW and NPWWE during pregnancy and postpartum (Table 1). After adjusting for confounding factors, PWWE were more likely to meet BDI threshold over the pregnancy+postpartum period compared to NPWWE, 46.2% vs 36.3%, respectively (p=0.048). PWWE were more likely to meet the EPDS threshold ( >11) in the postpartum compared to HPW, 8.9% vs 2.1%, respectively, but this was not significant after adjusting for confounding factors. BDI was highly correlated with BAI across all three groups (n=535, r2=0.731, p< 0.001).
In PWWE, factors associated with higher rates of depression by SCID criteria include: AED polytherapy, 90-day seizure frequency >1, lifetime history of major depression, and unplanned pregnancy. Risk factors for higher BDI scores were similar, plus a lifetime history of anxiety disorder and seizures during pregnancy (Table 2).
Rate of antidepressant use during pregnancy was significantly lower in PWWE (5.7%, p < 0.001) and HPW (3.9%, p = 0.005) vs NPWWE (15.7%). In the postpartum period, 24 PWWE (7.3%) and 5 HPW (4.9%) started antidepressant medications. Lifetime history of an anxiety disorder was significantly associated with higher rates of suicidal ideation in the postpartum period (based on the BDI) (p=0.007).
Conclusions: This large prospective study confirms previous reports of higher rates of psychiatric symptoms in PWWE compared to HPW and NPWWE. Our study identifies risk factors and extends previous work by including additional measures of anxiety, and underscores the importance of both lifetime history of anxiety and anxiety symptoms when assessing risk for depression and suicidal ideation.
Funding: Please list any funding that was received in support of this abstract.: Sources of Funding: NIH, NINDS and NICHD #U01-NS038455.
Clinical Epilepsy