Mental health counseling more effective at reducing preterm birth vs. antidepressants

Key takeaways:

• Receiving any mental health counseling was tied to a reduced preterm birth risk vs. untreated prenatal depression.
• Antidepressant use during pregnancy was tied to an increased preterm birth risk.

Mental health counseling is more effective at mitigating the risk for preterm birth compared with antidepressant treatment among pregnant women with depression, researchers reported in the American Journal of Obstetrics and Gynecology.

“Treating prenatal depression with mental health counseling appears to be effective in reducing the risk of preterm delivery associated with prenatal depression,” De-Kun Li, MD, PhD, research scientist in the division of research at Kaiser Foundation Research Institute at Kaiser Permanente, told Healio. “We note that this is the first study to evaluate this treatment effectiveness with mental health counseling and confirmation of these findings is needed. It is important that these findings be considered alongside the risks associated with depression relapse.”

Li and colleagues conducted a large, prospective, observational cohort study using Kaiser Permanente Northern California data from 82,170 pregnant women who delivered live births between 2014 and 2017. Researchers determined prenatal depression status by clinical diagnosis and identified treatment with either antidepressants or mental health counseling from the electronic health record system.

Twelve percent of women had clinically diagnosed prenatal depression.

Pregnant women with untreated vs. treated depression had a 41% increased preterm birth risk (adjusted HR = 1.41; 95% CI, 1.24-1.6). Receiving any mental health counseling was associated with an 18% reduced preterm birth risk compared with untreated depression (aHR = 0.82; 95% CI, 0.71-0.96).

An increased number of mental health counseling visits from two to three was associated with a 21% greater reduction in preterm birth risk (aHR = 0.79; 95% CI, 0.64-0.97) and four or more visits was associated with a 43% greater reduction (aHR = 0.57; 95% CI, 0.45-0.73). Antidepressant use during pregnancy was associated with an additional 31% increased preterm birth risk, which was independent of underlying depression (aHR = 1.31; 95% CI, 1.06-1.61). In addition, longer antidepressant use duration was tied to a 32% increased preterm birth risk with 60 to 120 days of use and a 64% increased risk with more than 120 days of use.

“These encouraging findings need to be confirmed by other researchers, but it is encouraging to be able to focus attention on a treatment — mental health counseling — that has few downsides in addressing a health outcome that has had few prevention strategies,” Li told Healio. “Randomized clinical trials to assess the beneficial effect of treating prenatal depression with mental health counseling on reducing preterm delivery may be considered to confirm the apparent effectiveness we found in this study.”

For more information:

De-Kun Li, MD, PhD, can be reached at dkl@dor.kaiser.org.