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Keywords:

  • antidepressants;
  • pharmacoepidemiology;
  • pregnancy;
  • pregnancy-induced hypertension

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT

• Antidepressants represent one of the most commonly used medications during pregnancy.

• There is a scarcity of information on impact of medications on maternal health outcomes.

• As the primary caregiver of the child, the mother's health and well-being should carry significant weight when making decisions regarding medication use during pregnancy.

WHAT THIS STUDY ADDS

• Antidepressant use during pregnancy is associated with increased risk of pregnancy-induced hypertension.

• These findings highlight the importance of further research evaluating the impact of gestational medication use on the health of the mother.

AIM Due to their effect on altering physiological interactions between vasodilator and vasoconstrictor autacoids in normal pregnancies, antidepressants may be associated with the risk of pregnancy-induced hypertension. We evaluated the impact of antidepressant use during pregnancy on the risk of pregnancy-induced hypertension.

METHODS We conducted a nested case–control study within the Quebec Pregnancy Registry, built by linkage of provincial medical, pharmaceutical, hospital and birth databases. We identified 1216 women with a diagnosis of pregnancy-induced hypertension with or without pre-eclampsia and with no history of hypertension before pregnancy. We randomly selected 10 controls for each case, matched on case index date (date of diagnosis) and gestational age. Odds ratios (OR) were calculated using conditional logistic regression models, adjusting for sociodemographic characteristics, maternal depression, anxiety, other chronic conditions, medication use and health service utilization.

RESULTS Among cases, 45 (3.7%) had used antidepressants during pregnancy compared with 300 (2.5%) in the control group (OR 1.52, 95% CI 1.10, 2.09). After adjusting for potential confounders, use of antidepressants during pregnancy was significantly associated with increased risk of pregnancy-induced hypertension (OR 1.53, 95% CI 1.01, 2.33). In stratified analyses, use of selective serotonin re-uptake inhibitors (OR 1.60, 95% CI 1.00, 2.55), and more specifically, paroxetine (OR 1.81, 95% CI 1.02, 3.23) was associated with risk of pregnancy-induced hypertension.

CONCLUSIONS Women who use antidepressants during pregnancy are at increased risk of pregnancy-induced hypertension with or without pre-eclampsia above and beyond the risk that could be attributed to their depression or anxiety disorders.