Brief: If you are pregnant, consult an expert before discontinuing mental health medication

Pregnant women with mental illness should consult an expert before stopping their medications, state officials said in a brief released Wednesday from the Maternal Death Review Board.

The recommendation was among several in the case brief as part of a larger statewide effort to focus on maternal health.

Other recommendations included screening for pregnant women for depression and better coordination between prenatal care providers and mental health professionals.

“Our results are shocking and clear,” said Dr. Marilyn Kasica, medical director for the US State Department’s Division of Family Health. “Based on our most recent data, mental health conditions were a contributor to 1 in 5 pregnancy-related deaths…Mental health is an essential component of physical health, and treatment must continue throughout pregnancy and the postpartum journey.”

what do you know

  • A woman taking psychiatric medications should not automatically stop taking them after pregnancy, according to a new release summary from the state’s Maternal Mortality Review Board.

  • Officials said mental health conditions were the third leading cause of pregnancy-related deaths in New York in 2018.

  • In the case brief, the review board highlighted recommendations and resources to help health care providers recognize and treat pregnant women with mental illness.

Officials said mental health conditions are the third leading cause of pregnancy-related deaths across New York, after embolism and hemorrhage. These findings were released by the Maternal Death Review Board earlier this year in a study of pregnancy-related deaths in 2018.

That report showed that of the 41 pregnancy-related deaths in 2018, 15% were due to mental health conditions. It also showed that black and non-Hispanic women had a pregnancy-related death rate five times higher than non-Hispanic white women.

The review board decided that mental health-related deaths were ‘likely preventable’ with the majority occurring between 43 and 365 days after the end of pregnancy.

The case brief — the first in a series — was released on Wednesday to highlight these findings and provide resources and guidance for providers.

Dr. Christina Deleganidis, director of women’s behavioral health at Northwell Health’s Zucker Hillside Hospital in Glen Oaks, Queens, called the results “eye-opening,” and said they’re also a reminder that mental health is physical health.

“Just as we pay attention to all the other medical things we need to take care of in the perinatal period, from blood pressure to blood sugar levels, it is just as important to see if the patient is improving emotionally and behaviorally,” he said.

One of the main recommendations for clinicians is that psychiatric medications should not be automatically discontinued just because a patient is pregnant. In some cases, pregnant women stop taking their medications due to concerns that they may adversely affect the fetus.

“They really need to talk to an expert who knows how the medication they’re taking can affect pregnancy,” said Karen Borstein, president and CEO of the Huntington-based nonprofit Family Services Association. “They can also change the medication. A lot of women experience difficulties during pregnancy and this can lead to depression.”

Borstein said pregnant women often suffer from other hardships, such as food insecurity and unemployment.

“If you are suffering from depression and not being treated for it during pregnancy, the results can be devastating,” she said.

Another recommendation in the brief was to improve education of emergency medicine providers so that they can better identify symptoms of mental illness in pregnant patients.

Deligiannidis also serves as the Medical Director of Reproductive Psychiatry for the New York State Project TEACH, which helps providers evaluate the treatment and management of mental health issues. She said providing these types of resources, referrals, and other services to providers is especially important for those whose primary training was not in mental health.

“If we had the right screening, if we had the right care coordination, if we had enough caregivers to care for patients with mood and anxiety disorders and other psychiatric illnesses or substance use disorders … we could have prevented this,” she said.

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