Brief: If pregnant, consult expert before stopping mental health drugs

Pregnant women with mental health conditions should check with an expert before weaning off their medications, state officials said in a brief released Wednesday from its Maternal Mortality Review Board.

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

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

“Our findings are shocking and clear,” said Dr. Marilyn Kacica, Medical Director for the State Department of Health’s Division of Family Health. “Based on our latest data, mental health conditions were contributing factors in 1 in 5 pregnancy associated deaths … Mental health is a core component of physical health, and it must continue to be treated through an individual’s pregnancy and post-partum journey.”

Officials said mental health conditions are the third leading cause of pregnancy-related deaths across New York, following embolisms and hemorrhages. Those findings were released by the Maternal Mortality Review Board earlier this year in a study of pregnancy-associated deaths from 2018.

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

The review board determined the mental-health related deaths were “potentially preventable” with the majority taking place between 43 and 365 days after the end of pregnancy.

The issue brief — the first in a series — was released Wednesday to highlight these findings and offer providers resources and guidance.

Describing the findings as “eye-opening," Dr. Kristina M. Deligiannidis, director of Women’s Behavioral Health at Northwell Health’s Zucker Hillside Hospital in Glen Oaks, Queens, said it's also a reminder that mental health is physical health.

“Just as we pay attention to all the other medical things that we need to take care of in our perinatal patients, from their blood pressure to their blood sugars, knowing if that patient is doing well emotionally and behaviorally is just as important,” she said.

One key recommendation to clinicians is that psychiatric medications should not be automatically discontinued just because a patient is pregnant. In some cases, pregnant women stop taking their medication because of concerns it could adversely impact the fetus.

“They really need to speak to an expert who will know how the medication they are on could impact the pregnancy,” said Karen Boorshtein, president and CEO of the nonprofit Family Service League based in Huntington. “They can also change the medication. A lot of women have difficulties during pregnancy and that can catapult them into depression.”

Boorshtein said pregnant woman often struggle with other difficulties such as food insecurity and unemployment.

“If you are depressed and you’re not being treated for it while pregnant, the outcomes could be devastating,” she said.

Another recommendation in the brief was improved education of emergency medicine providers so they can better spot symptoms of mental illness in pregnant patients.

Deligiannidis also serves as medical director of reproductive psychiatry for New York State Project TEACH, which helps providers assess treat and manage mental health concerns. She said providing these kinds 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 in place, if we had the right care coordination in place, and we had sufficient number of providers to care for patients with mood and anxiety disorders and other psychiatric illness or substance use disorders … we could have prevented these deaths,” she said.

By Lisa L. Colangelo

lisa.colangelo@newsday.com@lisalcolangelo

Lisa joined Newsday as a staff writer in 2019. She previously worked at amNewYork, the New York Daily News and the Asbury Park Press covering politics, government and general assignment.