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.