Antidepressant Use During Pregnancy Linked to Hypertension

Fran Lowry

March 21, 2012

March 21, 2012 — Women who use antidepressants while pregnant have an increased risk of developing pregnancy-induced hypertension, new research shows.

The increased risk is beyond the risk that could be attributed to their depression or anxiety disorders, Mary A. De Vera, PhD, from the University of Montreal, and Anick Bérard, PhD, from Sainte Justine Research Center, Montreal, Quebec, Canada, write.

Dr. Anick Bérard

"Antidepressants are used widely during pregnancy, up to 14% of pregnant women use them," Dr. Bérard told Medscape Medical News. "Our study adds one more piece to the puzzle with regard to the risk of using antidepressants during pregnancy."

The study is published online March 22 in the British Journal of Clinical Pharmacology.

Do Not Stop Meds

Selective serotonin reuptake inhibitors (SSRIs) are the main antidepressants in use today, and serotonin is a vasoconstrictor and also directly affects diastolic blood pressure, although the mechanism of action for this is not very well understood, Dr. Bérard noted.

In this study, the researchers analyzed data from the Quebec Pregnancy Registry and compared 1216 women who had been diagnosed with pregnancy-induced hypertension, with or without preeclampsia, who had no history of hypertension before they became pregnant, with 12,160 matched control individuals.

They found that among the participants with pregnancy-induced hypertension, 45 (3.7%) had used antidepressants during pregnancy, compared with 300 (2.5%) of the women in the control group (odds ratio [OR], 1.52; 95% confidence interval [CI] 1.10 - 2.09).

Antidepressant use during pregnancy was associated with a 53% increased risk for pregnancy-induced hypertension (OR, 1.53; 95% CI, 1.01 - 2.33). Use of SSRIs was associated with a 60% increased risk (OR, 1.60; 95% CI, 1.00 - 2.55); of the SSRIs, paroxetine was associated with the greatest risk for pregnancy-induced hypertension (OR, 1.81; 95% CI, 1.02 - 3.23).

"It is very important for physicians and women to discuss the risks and benefits of antidepressants before prescribing," said Dr. Bérard.

"Close monitoring needs to be done, because there could be benefits, and there can also be risks. The message isn't as simple as telling pregnant women to stop taking antidepressants.

"The decision has to be made one woman at a time. Anyone affected by this study should not stop taking their prescribed medication but seek a consultation with their doctor if they are concerned," she said.

"Important" Limitations

Linda Chaudron, MD, associate chair for clinical services in the Department of Psychiatry at the University of Rochester Medical Center in New York, said the study adds to recent studies that have explored the hypothesis of an association between antidepressant use and pregnancy-induced hypertension.

Dr. Linda Chaudron

She also pointed out that the study did not describe or explore the severity of the hypertension, its impact on the mother or the pregnancy, or need for treatment.

"The study findings must be understood within the context of the limitations of the study design. The study relies on data from a pregnancy registry and links 3 administrative databases. The data are from 1997 to 2003, which is important when considering the higher prevalence of paroxetine than other SSRIs.

"It uses the definition of 'at least one prescription filled between the 1st day of gestation and the index date' as the definition of exposure to an antidepressant. This is an important limitation, as women may fill a prescription but not take the medication, especially if they find out they are pregnant."

Nor does the study control for duration or dose of antidepressant, Dr. Chaudron said. In addition, "the authors are not able to account for untreated or undertreated depression, severity of current symptoms, or remission of symptoms," she said.

Furthermore, Dr. Chaudron pointed out that the authors themselves note that other important risk factors for pregnancy-induced hypertension, such as smoking and obesity, race/ethnicity, exercise, alcohol or substance use and abuse, and use of over-the-counter medications, were not controlled for in the study.

She also drew attention to the fact that the absolute number of women taking SSRIs was quite small, only 45 in the group with pregnancy-induced hypertension.

"It is important to always consider the full set of risks and benefits for women and their individual situations," she concluded.

Individual Decision

Nada Stotland, MD, professor of psychiatry at Rush Medical College in Chicago, Illinois, emphasized that maternal depression is not good for the mother or for the child. Nor is it good for the cardiovascular system.

Dr. Nada Stotland

A weakness of this study, Dr. Stotland said, was the lack of a comparison between depressed women who did not take medication with those who did.

"Once you interrupt an antidepressant, sometimes it's hard to get it to work as well. One study showed that two-thirds of women who went off their antidepressants became depressed again, so the bottom line is, this is an individual decision," she said. "There is no easy answer."

Dr. Stotland also cautioned that women reading about the results of this study might panic and stop taking their antidepressants, something that could be harmful.

"The reaction should not be knee jerk. In this study, hypertension increased, but they don't really say by how much it increased. So women who are on antidepressants should not become alarmed. Instead, they should talk with their doctor if they have concerns."

The study was funded by the Fonds de la Recherche en Santé Québec. Dr. Bérard reports that she was a consultant in the litigation involving antidepressants. Dr. Chaudron and Dr. Stotland have disclosed no relevant financial relationships.

Br J Clin Pharmacol. Published online March 22, 2012. Abstract

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