Objective: This case report highlights antenatal depression as a common condition with potentially grave outcomes if left untreated. However, treatment options can be limited by the need to protect the fetus from medication-induced side effects. Methods: We report a young female obstetric patient who was carrying twins conceived through assisted reproduction, and her pregnancy was complicated by placenta previa major and repeated antepartum hemorrhages, which necessitated multiple admissions and strict bed rest. She became intensely depressed and anxious, developed suicidal ideation and refused examinations that were necessary to her physical health. She was referred to a psychiatrist and was given low-dose medication, supportive counseling, and case management. Results: She responded well to treatment, showing marked improvement in her mood and cooperation with obstetric care. Her twins were delivered at 35 weeks’ gestation in good health. Her progress was maintained into the postpartum period. Conclusions: This case of antenatal depression was successfully treated using a combination of medication, case management and psychological support. It adds to evidence that this illness benefits from early identification and is highly treatable.
Pregnancy, High-Risk ; Antidepressive Agents

Objective: This is the first Singaporean study to examine prescribing practices among clinicians treating women with antenatal psychiatric conditions. This study aims to describe the characteristics of pregnant women who were prescribed psychotropic for new-onset antenatal psychiatric conditions. It also examines psychotropic prescription patterns and explores associations between antidepressant/benzodiazepine prescription and clinical characteristics. Methods: Pregnant women who were seen by psychiatrists from the Mental Wellness Service at the Kandang Kerbau (KK) Women’s and Children’s Hospital over a four-year period for new-onset antenatal psychiatric conditions, and who were prescribed psychotropic medication, were eligible for inclusion in the study. Demographic and obstetric information, psychiatric diagnoses and prescription of psychotropic were recorded in a database. Descriptive analyses were performed and associations between antidepressant/benzodiazepine prescription and clinical characteristics were studied. Results: A total of 110 patients were included in the study. The majority of the subjects were diagnosed with antenatal depression. Most of the subjects were prescribed an antidepressant in combination with Promethazine. Low-dose Dothiepin was the antidepressant of choice. Subjects with antenatal depression were more likely to be prescribed antidepressants (odds ratio (OR) 5.30, 95% confidence interval (CI) 2.29-12.27; p<0.01) while subjects with an adjustment disorder were less likely to be prescribed antidepressants (OR 0.11, 95% CI 0.02-0.52; p=0.001). No significant associations were found between antidepressant prescription and diagnoses of antenatal anxiety or mixed depression-anxiety. Nulliparous subjects were less likely to be prescribed an antidepressant or benzodiazepine, compared to subjects with a history of previous births (OR 0.35, 95% CI 0.16-0.79; p=0.01 and OR 0.91, 95% CI 0.84-0.98; p=0.03 respectively). Conclusions: Future studies of psychotropic prescription for pregnant psychiatric patients should examine severity of symptoms at presentation, timing of first presentation in relation to gestational age, patients’ willingness to accept medication and response to psychotherapy. More studies are needed to explore the association between parity and antidepressant prescription.

INTRODUCTION: Expectant mothers may appear anxious even during healthy pregnancies. Unfortunately, little is known about antenatal anxiety, and affected women may remain undetected and untreated. This study aimed to examine the prevalence, incidence, course and associations of high state anxiety in routine obstetric care. MATERIALS AND METHODS: This was an observational prospective cohort study at a large maternity unit. Obstetric outpatients with low-risk singleton pregnancies were recruited during first trimester consultations. Participants provided sociodemographic data and completed the State-Trait Anxiety Inventory (STAI) and Edinburgh Postnatal Depression Scale. The STAI was re-administered at each subsequent trimester. RESULTS: Prevalence and incidence of  high state anxiety among 634 completers were 29.5% (95% CI 25.6%-33.6%) and 13.9% (95% CI 9.9%-18.0%), respectively. Anxiety was persistent in 17.0% (95% CI 14.3%-20.2%) and transient in 26.3% (95% CI 23.1%-29.9%). Only persistently anxious participants had high mean second trimester state anxiety scores. Odds for anxiety of greater persistence increased by 29% (95% CI 24%-35%) per 1-point increase in first trimester depression scores, and decreased by 36% (95% CI 7%-56%) with tertiary education. CONCLUSION Antenatal anxiety symptoms are common even in normal pregnancies, especially among women with depression and lower education. Our study indicates value in exploring diagnostic criteria and quantitative measures for antenatal anxiety.
Adult ; Anxiety Disorders ; diagnosis ; epidemiology ; Cohort Studies ; Confidence Intervals ; Depressive Disorder ; diagnosis ; epidemiology ; Female ; Humans ; Odds Ratio ; Pregnancy ; Pregnancy Complications ; diagnosis ; epidemiology ; Pregnancy Outcome ; Pregnancy Trimester, First ; Prenatal Diagnosis ; Prevalence ; Prospective Studies ; Risk Assessment ; Severity of Illness Index ; Singapore

Pregnancy ; Female ; Humans ; COVID-19/epidemiology* ; Singapore ; Telemedicine ; SARS-CoV-2 ; Parturition

INTRODUCTIONAntenatal major depression is a relatively common and potentially debilitating illness, but knowledge of its treatment outcomes and strategies is still lacking. This study aimed to explore the clinical profiles and treatment outcomes of patients with antenatal major depression, to look for patterns and associations that could guide subsequent research and clinical applications.

METHODSFrom May 2006 to November 2010, 118 consecutive patients with antenatal major depression were naturalistically assessed over eight months of individualised therapy, and their characteristics were assessed as potential predictors of treatment outcome.

RESULTSAll participants accepted supportive counselling and case management, although only 51 (43.2%) participants accepted low-dose antidepressant therapy. Overall, 95 (80.5%) of them were successfully discharged, while 12 (10.2%) required extended treatment into the postnatal period. An equation for prognosticating the need for extended treatment was obtained using multiple logistic regression analysis, which incorporated three predictors: previous depression (odds ratio [OR] 12.4, 95% confidence interval [CI] 1.40-110; p = 0.024); maternal age < 26 years or > 35 years (OR 6.88, 95% CI 1.67-28.4; p = 0.008); and no use of antidepressant (OR 6.94, 95% CI 0.79-60.9; p = 0.080). Among participants with previous depression and at either extreme of maternal age, the number needed to treat with antidepressants to avert extended treatment was three.

CONCLUSIONThe majority of women with antenatal major depression recovered after receiving short-term treatment. Those with previous depression and who were of relative extreme maternal age were most likely to benefit from antidepressant treatment to expedite recovery.