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.

The prevalence of postnatal depression (PND) was reported to be 6.8% in an obstetric setting in Singapore. Since primary care physicians are the healthcare clinicians most likely to interact with postnatal mothers in Singapore, they are in the best position to screen for PND and help new mothers. PND affects the well-being of the mother, her baby and those around her. If left untreated, depression can result in lasting adverse outcomes such as unfavourable parenting practices, impaired mother-infant bonding, impaired intellectual and emotional development of the infant, maternal suicide, and even infanticide. The Edinburgh Postnatal Depression Scale and the Patient Health Questionnaire-2 are effective screening tools that can be easily used in primary care settings for screening at-risk mothers. Herein, we discuss the management options available in primary care settings, as well as share some local resources available to mothers and the benefits of timely intervention.
Depression, Postpartum ; diagnosis ; epidemiology ; psychology ; Family Practice ; Female ; Global Health ; Humans ; Incidence ; Mothers ; psychology ; Physician's Role ; Prevalence ; Psychometrics ; methods