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A study presented at the Society for Maternal-Fetal Medicine (SMFM) 2026 Pregnancy Meeting quantifies a pattern that managed care organizations have long had financial and clinical reason to address: when pregnant patients stop their antidepressants, psychiatric emergency department visits nearly double — generating avoidable acute care costs at one of the highest-acuity, highest-cost points in the care continuum.
Zafman and colleagues analyzed pharmacy claims from a private Pennsylvania insurer for patients who delivered in 2023 or 2024 and who had active SSRI or SNRI prescriptions prior to conception. Of 1,462 patients with detailed claims data, only 17.6% continued medications without interruption. The remaining 82% either stopped entirely or had gaps exceeding 60 days. Psychiatric ED visit rates among those who discontinued peaked at 58 per 1,000 patients in the second month of pregnancy, compared with 37 per 1,000 among continuers, and spiked again in the late third trimester — 59 versus 29 per 1,000. Elevated utilization persisted into the postpartum period.
For health plans, the cost implications extend beyond individual ED visits. Untreated perinatal psychiatric disorders are associated with preeclampsia, preterm birth, and low birth weight — all high-cost delivery and NICU-associated outcomes. Postpartum depression that follows inadequately treated antenatal illness further extends the utilization window.
The most common prescribers in the cohort were family medicine physicians and primary care nurse practitioners, rather than psychiatrists or obstetricians and gynecologists— underscoring the role of primary care networks in medication continuity monitoring. Plans with care management programs targeting high-risk pregnancies would benefit from incorporating SSRI/SNRI fill adherence as a flaggable metric.
The abstract will be published in the February 2026 issue of PREGNANCY, the official journal of the SMFM.
