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Are women empowered to make decisions about the use of antidepressants in pregnancy?

02 May 2018
12 min read
Volume 26 · Issue 5

Abstract

Background

Untreated depression is related to maternal mortality and morbidity. The most frequent treatment is antidepressant medication, but studies have shown that women find decisions about the use of antidepressants in pregnancy difficult and confusing.

Aim

To explain if women are empowered to make decisions around the use of antidepressants in pregnancy.

Methods

A literature review was conducted using CINAHL Complete, Intermid, Proquest and Discover More.

Findings

Information provision was inadequate and women experienced decisional conflict. Women wanted to be involved in a collaborative decision-making process.

Conclusions

Women want to be provided with clear and accurate information and prefer to collaborate when making decisions about antidepressants in pregnancy. More research is needed to explore demographic gaps within population samples, and women's experiences of decision-making about antidepressant usage. Undergraduate and postgraduate health education should include conversation skills training, associated with collaborative discussion and informed choice.

Depression and anxiety are two of the most common health problems in pregnancy in the UK, affecting 12% and 13% of women, respectively (Heron et al, 2004; Gavin et al, 2005; Vesga-Lopez et al, 2008). The most common treatment is antidepressant medication (McManus et al, 2016). According to Einarson (2013), in 2013, antidepressants were the most researched drugs during pregnancy, and the findings related to risk of adverse effects for the fetus generated more than 30 000 potential outcomes. Outcomes included, spontaneous abortion, low birth weight, preterm birth, congenital malformations, neonatal withdrawal syndrome and persistent pulmonary hypertension of the newborn, in addition to the maternal morbidity incurred as a consequence of poor outcome (Bonari et al, 2004; Chan et al, 2014; UK Teratology Information Service (UKTIS), 2016). However, risks are difficult to quantify due to conflicting findings from teratological research (UKTIS, 2016) and the observational methods used, since pregnant women are not included in randomised controlled trials for antidepressant drugs (Einarson et al, 2015). Ambiguity around risk factors makes decision-making about antidepressant usage during pregnancy a complex process (Bonari et al, 2005; Patel et al, 2011; Stepanuk et al, 2013; Walton et al, 2014). This literature review therefore seeks to explore whether women feel empowered to make complex decisions about antidepressants in pregnancy.

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