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Selective Serotonin Reuptake Inhibitor Use in Pregnancy and Protective Mechanisms in Preeclampsia
Julie A Vignato1, S Banu Gumusoglu2, Heather A Davis3
1College of Nursing, University of Iowa, Iowa City, IA, 52242, USA.
Reproductive Sciences (Thousand Oaks, Calif.)
|August 19, 2022
Summary
Selective serotonin reuptake inhibitors (SSRIs) may reduce preeclampsia risk in pregnant individuals. SSRIs were associated with decreased preeclampsia incidence and lower vasopressin levels, suggesting a potential therapeutic role.
Area of Science:
- Perinatal Medicine
- Neuropharmacology
- Reproductive Health
Background:
- Depression and preeclampsia share risk factors and exhibit a bidirectional relationship.
- Epidemiological studies suggest a link between SSRI use during pregnancy and preeclampsia, yet mechanistic insights propose potential protective effects.
- Clarifying the association between SSRIs and preeclampsia is crucial for understanding therapeutic potential.
Purpose of the Study:
- To investigate the association between SSRI use and preeclampsia incidence in a large retrospective cohort.
- To explore the relationship between SSRI use, depression severity, and plasma copeptin levels (a marker of vasopressin secretion).
- To examine the potential modulation of preeclampsia risk and underlying mechanisms by SSRIs.
Main Methods:
- Retrospective cohort study including 9558 SSRI-untreated and 9046 SSRI-treated pregnancies.
- Measurement of maternal plasma copeptin in a subcohort (n=233) using enzyme-linked immunosorbent assay.
- Analysis of diagnoses and depression symptoms (PHQ-9) via medical records review; statistical analyses included descriptive, univariate, and multivariate regression.
Main Results:
- SSRI use was associated with a decreased risk of preeclampsia (OR=0.9, p=0.05) after controlling for confounders.
- Moderate-to-severe depression symptoms correlated with significantly higher copeptin levels compared to mild/no depression.
- SSRIs significantly attenuated first-trimester plasma copeptin levels (p < 0.001) and were associated with lower copeptin in preeclampsia cases (p=0.04).
Conclusions:
- SSRI use in pregnancy may be associated with a reduced risk of preeclampsia.
- SSRIs appear to modulate vasopressin secretion, as indicated by lower copeptin levels, potentially influencing preeclampsia pathophysiology.
- Further research is warranted to elucidate the intricate interplay between serotonin, vasopressin, depression, and preeclampsia.
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