Maternal depression and medication exposure during pregnancy: comparison of maternal retrospective recall to prospective documentation

Objective Outcome investigations of prenatal maternal depression and psychotropic exposure rely extensively on maternal retrospective recall. This study compared postnatal recall to prospective documentation of illness and medication exposures. Design Prospective cohort and retrospective case-control studies. Setting Emory Women's Mental Health Program (prospective study) and Emory University Department of Psychology (retrospective study). Sample A total of 164 women who participated in both the prospective and retrospective studies. Methods Women with a history of mental illness were followed during pregnancy for prospective prenatal assessments of depression and medication exposures. At 6 months postpartum, some of these women also participated in a retrospective study during which they were asked to recall prenatal depression and medication use. Agreement between prospective and retrospective documentation of exposures was analysed. Main outcome measures Occurrence of maternal depression during pregnancy and maternal use of pharmacological agents during pregnancy. Results There was only moderate agreement (k = 0.42) in prospective versus retrospective reporting of prenatal depression. Positive predictive value for recalling depression was 90.4%; however, negative predictive value for denying depression was only 53.8%. Participants accurately recalled psychotropic use but significantly underreported use of nonpsychotropic medications. Conclusions Studies using retrospective data collection may be susceptible to systematic recall bias with underreporting of maternal depression and use of nonpsychotropic agents during pregnancy.