Perinatal depressive risk in pregnancies complicated by fetal anomalies

National rates of perinatal depression range from 15-20% in women and 2-8% in male partners. Depressive risk is likely higher in pregnancies complicated by fetal anomalies. We sought to determine the frequency of depressive risk in a cohort of pregnant women and partners with pregnancies complicated by a prenatal diagnosis of a congenital anomaly. Postpartum Depression Screening Scale (PDSS) and Center for Epidemiological Studies-Depression (CES-D) were used to identify significant depressive risk in a cohort of pregnant patients and their partners at a single center from December 1, 2012 through July 1, 2021. Demographics, fetal anomaly classification, and antidepressant medication (ADM) use were evaluated. Fetal diagnosis category was based on primary anomaly; multiple anomalies or known genetic syndromes were categorized as miscellaneous. 5,279 women and 3,997 men completed screening. 2,612 women (49.5%) and 557 partners (14.0%) screened positive for depressive risk 2-3 weeks after receiving a confirmed diagnosis of a congenital anomaly. The rate of positive depressive risk by type of anomaly is presented in the table. In pregnant women, congenital diaphragmatic hernia was associated with highest rate of depressive risk. In male partners, a neurologic diagnosis had the highest rate of positive depressive risk. Within the maternal cohort, 25.3% (801/3,168) reported use of ADM (current or historical). Of those women with a positive screen, 35.2% (681/1935) reported current or historical use of ADM. Rates of perinatal depressive risk approach 50% in the pregnant patient and occur in 14% of partners after diagnosis of a congenital anomaly. The risk of major depression is likely significantly higher than reported national rates of depression in pregnant patients and partners in this setting. Identifying expectant parents at risk of depression allows for integration of psychosocial support and intervention during the pregnancy. Streamlined access to psychosocial services in these complex pregnancies is an essential part of perinatal care.