No Higher Risk for Adverse Pregnancy Outcomes

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Hypertension in being pregnant is normally outlined as a diastolic blood force of 90 mm Hg or increased or a systolic pressure at or above 140 mm Hg. Preeclampsia is outlined as the improvement of hypertension alongside with proteinuria or edema throughout being pregnant, commonly in the 2nd 50 % of gestation. Preeclampsia is much more typical in women of all ages who have not carried a preceding pregnancy outside of 20 months and in women of all ages at both extreme of their reproductive a long time.

Accurately what brings about preeclampsia is not absolutely comprehended. Because serotonin performs a purpose in vascular perform and the regulation of blood strain, some have questioned irrespective of whether the use of serotonin reuptake inhibitor (SRI) antidepressants could affect a woman’s danger for hypertension or preeclampsia. Although quite a few observational reports have indicated an greater risk of hypertension and/or preeclampsia in gals using SRIs in the course of being pregnant, this acquiring is not consistent, and most of these scientific tests have been smaller and have not been equipped to account for opportunity confounding components.

Meta-Analysis: SSRIs and Chance for Hypertension and Preeclampsia

To much better estimate the possibility of gestational hypertension and preeclampsia in girls using SSRI antidepressants all through pregnancy, Gumusoglu and colleagues performed a meta-analysis of observational cohort or populace reports of women who applied SSRIs during pregnancy, deciding upon scientific tests that exclusively dealt with the query of whether gestational SSRI use modulates hazard of preeclampsia and/or gestational hypertension. The final evaluation integrated nine research revealed concerning 2009 and 2020, including somewhere around 40,000 SSRI-exposed pregnancies.

Among the 9 integrated studies, two evaluated possibility of gestational hypertension and seven evaluated threat of preeclampsia. Of the 9 research assessed, a few noted a statistically considerable boost in danger of gestational hypertension or preeclampsia in SSRI-exposed pregnancies. Four scientific tests described a non-sizeable maximize in threat of preeclampsia or gestational hypertension with SSRI use for the duration of being pregnant. The pooled relative risk (RR) of gestational hypertension or preeclampsia was 1.43 (95 % CI: 1.15–1.78, P < 0.001).

While this meta-analysis does show a small, statistically significant association between prenatal SSRI exposure and risk of gestational hypertension or preeclampsia, the authors note some important limitations of this meta-analysis. Most importantly, most of the studies included in the meta-analysis failed to account for anxiety/depression severity, SSRI dose, and/or other well-defined preeclampsia risk factors (e.g., obesity, diabetes, smoking, race). The most common limitation of the included studies was the failure to account for anxiety/depression severity in the mother, which may independently drive risk for gestational hypertension and/or preeclampsia.

The Link Between Depression and Preeclampsia

Gumusoglu and colleagues note that women who use SSRIs in pregnancy may have increased risk for preeclampsia simply because they also have more severe depressive illness, which has been identified as an independent preeclampsia risk factor in other studies (Qiu et al, 2007). In fact, they note that when specific dimensions of maternal mental health are accounted for, the relative risk for preeclampsia among SSRI users is not significant, as observed in the study from Palmsten and colleagues (RR 1.16, 95 % CI 0.92–1.45). Similarly, after accounting for lifetime major depressive episodes, SSRI use in early and mid-pregnancy does not significantly increase preeclampsia risk (Lupattelli et al, 2017). Making the analysis of this association even more complicated is the fact that several preeclampsia risk factors (including obesity, metabolic syndrome, and cardiovascular disease) are more common in women with depression.

Is it Possible that SSRIs May Actually Decrease Risk for Preeclampsia

While this meta-analysis does show a small, statistically significant association between prenatal SSRI exposure and risk of gestational hypertension or preeclampsia, there are important limitations to consider. Most studies fail to account for well-defined preeclampsia risk factors (e.g., obesity, diabetes, smoking, race). Furthermore, there is increasing evidence to indicate that anxiety and/or depression in the mother may independently drive risk for gestational hypertension and/or preeclampsia.

It is biologically plausible that SRIs may actually decrease risk for preeclampsia. Both depression and preeclampsia are associated with dysregulation of serotonergic neurotransmitter systems thus, it is plausible that medications, such as SRI antidepressants, that improve serotonergic regulation may also help to decrease depressive symptoms, as well as decrease vulnerability to preeclampsia. In an upcoming post, we will discuss a preliminary study that supports this hypothesis. Stay tuned.

While future studies will help to clarify the complex interaction between depression, SSRI treatment and pre-eclampsia, the information we have thus far is reassuring. If there is a risk of preeclampsia associated with SSRI treatment, the risk appears to be relatively small. However, there is considerable data to indicate that risk of preeclampsia is higher in women with depressive illness (even in the absence of treatment with an SSRI) and may be affected by other co-occurring risk factors, such as obesity, chronic hypertension, diabetes mellitus, and smoking.

Ruta Nonacs, MD PhD