Elevated risk of preeclampsia in pregnant women with depression: depression or antidepressants?

Abstract

A previous study suggested an increased risk of preeclampsia among women treated with selective serotonin reuptake inhibitors (SSRIs). Using population-based health-care utilization databases from British Columbia (1997-2006), the authors conducted a study of 69,448 pregnancies in women with depression. They compared risk of preeclampsia in women using SSRIs, serotonin-norepinephrine reuptake inhibitors (SNRIs), or tricyclic antidepressants (TCAs) between gestational weeks 10 and 20 with risk in depressed women not using antidepressants. Among prepregnancy antidepressant users, the authors compared the risk in women who continued antidepressants between gestational weeks 10 and 24 with the risk in those who discontinued. Relative risks and 95% confidence intervals were estimated. The risk of preeclampsia in depressed women not treated with antidepressants (2.4%) was similar to that in women without depression (2.3%). Compared with women with untreated depression, women treated with SSRI, SNRI, and TCA monotherapy had adjusted relative risks of 1.22 (95% confidence interval (CI): 0.97, 1.54), 1.95 (95% CI: 1.25, 3.03), and 3.23 (95% CI: 1.87, 5.59), respectively. Within prepregnancy antidepressant users, the relative risk for preeclampsia among continuers compared with discontinuers was 1.32 (95% CI: 0.95, 1.84) for SSRI, 3.43 (95% CI: 1.77, 6.65) for SNRI, and 3.26 (95% CI: 1.04, 10.24) for TCA monotherapy. Study results suggest that women who use antidepressants during pregnancy, especially SNRIs and TCAs, have an elevated risk of preeclampsia. These associations may reflect drug effects or more severe depression.

Figure 1.

Study timeline, British Columbia health-care utilization data, 1997–2006. LMP, last menstrual period; Wk, week.

Figure 2.

Risk for preeclampsia, British Columbia health-care utilization data, 1997–2006. A, risk according to exposure between gestational weeks 10 and 20 among women with depression diagnoses before week 20; B, risk according to type of antidepressant continuation between weeks 10 and 24 and antidepressant discontinuation before week 10 among women with depression diagnoses before week 10 and at least 1 dispensing for only selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), or tricyclic antidepressants (TCAs) during the 3 months prior to the last menstrual period. AD, antidepressant.

Figure 3.

Timing analysis among 306,831 pregnancies regardless of depression status, British Columbia health-care utilization data, 1997–2006. Relative risks (RRs) and 95% confidence intervals (CIs) comparing the risk for preeclampsia in women with dispensings for selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and tricyclic antidepressants (TCAs) in 2-month periods versus women with no claims for any antidepressants from the start of baseline until the end of the period of interest. Months to the left of the last menstrual period (LMP) are prior to the LMP, and months to the right of the LMP are after the LMP.