Abstract
Background:
The prevention of postpartum depression is an important area of investigation given its association with major maternal and neonatal sequelae, yet few evidence-based treatments to reduce the frequency of postpartum depression are utilized. Recent data suggest that N-methyl-D-aspartate receptor antagonists may lead to rapid improvement of depressive symptoms lasting up to 2 weeks. We hypothesized that the N-methyl-D-aspartate receptor antagonist magnesium sulfate would elicit antidepressant effects subsequent to its receipt by women receiving peripartum seizure prophylaxis for a hypertensive disorder of pregnancy.
Objective:
To compare the frequency of depressive symptoms at 2 weeks and 6 weeks postpartum between women who did or did not receive peripartum magnesium sulfate for a hypertensive disorder of pregnancy.
Study design:
This prospective cohort study included women with a hypertensive disorder of pregnancy ≥34 weeks of gestation with singleton gestations. Magnesium sulfate for seizure prophylaxis was administered at obstetrician discretion. The Quick Inventory of Depressive Symptomatology was administered prior to hospital discharge and again at 2 weeks and 6 weeks postpartum to assess for postpartum depressive symptoms. The primary outcome for this study was the change in Quick Inventory of Depressive Symptomatology score from baseline to 2 weeks postpartum, which was analyzed both continuously and categorically (any symptom worsening versus stability/improvement). Secondary outcomes included the change in Quick Inventory of Depressive Symptomatology score from baseline to 6 weeks postpartum and the proportion of women who experienced an increase in Quick Inventory of Depressive Symptomatology score at 6 weeks postpartum.
Results:
Of the 342 women enrolled, 39% (N=134) received magnesium sulfate. Compared to women who did not receive magnesium, women who received magnesium had a significantly smaller change in their mean Quick Inventory of Depressive Symptomatology score (0.6 ± 3.4 vs. 1.6 ± 3.0, p= 0.015) and also were less likely to have an increase in Quick Inventory of Depressive Symptomatology score at 2 weeks postpartum (52% vs. 67%, p=0.022). These differences were not present at 6 weeks postpartum. After controlling for potential confounders, women who received magnesium continued to have a lower odds of having an increased Quick Inventory of Depressive Symptomatology score from baseline at 2 weeks postpartum compared to women who did not receive magnesium (aOR 0.88, 95% CI 0.78-0.98).
Conclusion:
Peripartum magnesium was associated with less of an exacerbation in depressive symptoms in the immediate postpartum period. Given the implications of postpartum depression on maternal and child health and the lack of existing prophylaxis, randomized trials should examine this novel potential prophylactic therapy.
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