This depression often remains unrecognized because many discomforts of pregnancy are similar to symptoms of depression. 12 Pregnant women with depression are at risk for poor nutrition, substance abuse, and noncompliance with prenatal care. Also, they have a greater potential for child abuse and neglect. Because depression during pregnancy is a strong predictor of postpartum depression, the antepartum period is an optimum time for screening, diagnosis, and treatment. The decision to treat the pregnant depressed woman presents a dilemma for both the patient and the physician.
Few guidelines exist primarily because antepartum depression has been underdiagnosed.
Therefore, few treatment trials have been conducted. In addition, the unknown effects of stress, depression, and anxiety on the fetus must be considered and may contribute substantially to fetal distress or neonatal outcome. Therefore, the decision to treat depression during gestation must be determined by balancing maternal well-being with fetal safety. Recent data suggest that depression during pregnancy increases perinatal risk. Therefore, the seriousness of the mother's illness, the likelihood of recurrence, and the available support systems all must be considered by the physician, patient, and significant other.