Selective serotonin reuptake inhibitor use and risk of gestational hypertension

Abstract

Objective: The purpose of this study was to assess the effects of treatment with selective serotonin reuptake inhibitors (SSRIs) on the risks of gestational hypertension and preeclampsia.

Method: The authors analyzed data from 5,731 women with nonmalformed infants and no underlying hypertension who participated in the Slone Epidemiology Center Birth Defects Study from 1998 to 2007. Gestational hypertension was defined as incident hypertension diagnosed after 20 weeks of pregnancy, with and without proteinuria (i.e., with and without preeclampsia). The risks of gestational hypertension and preeclampsia were compared between women who did and did not receive SSRI treatment during pregnancy. Relative risks and 95% confidence intervals (CIs) were estimated using the Cox proportional hazards model, adjusting for prepregnancy sociodemographic, lifestyle, reproductive, and medical factors.

Results: Gestational hypertension was present in 9.0% of the 5,532 women who were not treated with SSRIs and 19.1% of the 199 women who were treated with SSRIs. Among women who received treatment, gestational hypertension was present in 13.1% of the 107 women who received treatment only during the first trimester and in 26.1% of the 92 women who continued treatment beyond the first trimester. The occurrence of preeclampsia was 2.4% among women who were not treated with SSRIs, 3.7% among women who were exposed to SSRIs only during the first trimester, and 15.2% among women who continued SSRI treatment beyond the first trimester. Relative to women who did not receive treatment, the adjusted relative risk of preeclampsia was 1.4 for women who discontinued treatment and 4.9 for women who continued treatment.

Conclusion: SSRI exposure during late pregnancy-whether a causal factor or not-might identify women who are at an increased risk for gestational hypertension and preeclampsia. Further investigation is needed in order to separate the effects of treatment with SSRIs from those of underlying mood disorders.

Figure 1

Antidepressant use in relation to the last menstrual period, Slone Epidemiology Center Birth Defects Study, 1998-2007 * * SSRI: selective serotonin reuptake inhibitor. Non-SSRI antidepressants include tricyclic antidepressants, serotonin/norepinephrine reuptake inhibitors, and other antidepressant

Figure 2

Cumulative incidence of gestational hypertension and preeclampsia by selective serotonin reuptake inhibitor (SSRI) use, Slone Epidemiology Center Birth Defects Study, 1998-2007 * * Non-users (N=5,532) were women who were not exposed to SSRIs from two months before pregnancy through delivery; Discontinuers (N=107) were women who used SSRIs two months before pregnancy, but stopped taking them by the end of the first trimester; Continuers (N=92) were women who used SSRIs two months before pregnancy, and continued to use them after the first trimester

Figure 2

Cumulative incidence of gestational hypertension and preeclampsia by selective serotonin reuptake inhibitor (SSRI) use, Slone Epidemiology Center Birth Defects Study, 1998-2007 * * Non-users (N=5,532) were women who were not exposed to SSRIs from two months before pregnancy through delivery; Discontinuers (N=107) were women who used SSRIs two months before pregnancy, but stopped taking them by the end of the first trimester; Continuers (N=92) were women who used SSRIs two months before pregnancy, and continued to use them after the first trimester