Antidepressant use during pregnancy and the risk of pregnancy-induced hypertension

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.

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.

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.

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.