Grant: CIHR Fellowship

Depression and anxiety during pregnancy have been linked with adverse birth outcomes. However, managing maternal mental illness during pregnancy with prescription medicines is not without risks. For example, the use of some types of antidepressants during pregnancy has been associated with increased risk of preterm birth, small for gestational age (SGA) birth, respiratory distress, septal heart defects, and persistent pulmonary hypertension. However, being of low socioeconomic status (SES) during pregnancy has also been associated with poor outcomes for the newborn, including increased risk of preterm birth, SGA birth, still birth and neonatal and infant death, and, while it has not been adequately studied in Canadian populations, American literature suggests that low SES also increases the risk of the mother experiencing depression and/or anxiety during pregnancy. Finally, preliminary studies examining the relationship between SES and the use of antidepressant medicines during pregnancy in British Columbia indicate that pregnant women of low SES are significantly more likely to be using these medicines. These relationships suggest that some of the negative infant outcomes that were previously thought to be caused by use of antidepressants during pregnancy may partly, or even primarily, result from the effects of being of low SES during pregnancy. I aim to clarify the relationship between SES, maternal depression and anxiety during pregnancy, use of antidepressants during pregnancy and infant outcomes. Clearly understanding these relationships will lead to a more accurate understanding of the risks associated with antidepressant use during pregnancy. A clearer picture of these risks will enable providers to make the safest and most effective decisions for both mother and newborn when treating pregnant women with depression or anxiety.