Antidepressants and hypertensive disorders in pregnancy: a retrospective cohort analysis

Carolyn Breadon^1*Shalini Arunogiri²Alisa Turbić³Alex Lavale¹Ricardo Maldonado⁴Jayashri Kulkarni¹

• ¹Monash University, Melbourne, Australia
• ²Monash Addiction Research Centre, Faculty of Medicine, Nursing & Health Sciences, Monash University, Melbourne, Victoria, Australia
• ³Department of Psychiatry, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
• ⁴Powerstats, North Ryde, Australia

Objective: This study investigated relationships between antidepressant use in pregnancy and hypertensive disorders of pregnancy. Design/Setting/Sample: Observational cohort study examining 75,308 births. Methods: Logistic regression analysis. The antidepressant treatment cohort was compared with two groups: all births at this hospital within this time period, and a depressed/anxious cohort not treated with antidepressants in pregnancy. Main Outcome Measures: diagnoses of hypertension, pre-eclampsia or eclampsia, treatment with antihypertensive medication. Results: A statistically significant relationship (p=0.001) between antidepressant use in pregnancy and clinically diagnosed hypertension, OR 2.65, CI 1.45-4.81, when compared with the overall birthing cohort. When covariates were added, including BMI, age and gestational diabetes, this relationship lost statistical significance. The relationship was also non-significant when a depressed/anxious cohort was used as the comparator group: OR 1.49 (p = 0.24, CI 0.77 – 2.88). A highly statistically significant relationship was found between antenatal antidepressant use and pre-eclampsia, OR 2.90, (p < 0.0005, CI 2.1 – 4.0), which retained significance when covariates were added to the regression analysis (OR 2.07, CI 1.45-2.97, p<0.0005). BMI and gestational diabetes were also significant risk factors for pre-eclampsia in this sample. As in other research, depression was also found to be related to pre-eclampsia at a borderline significant level (p=0.086). . When women taking antidepressants were compared with depressed/anxious peers a similarly significant relationship between antidepressant use and hypertension of pregnancy was found: OR 2.56, (p < 0.0005, CI 1.7 – 3.7). We found a highly significant relationship between antidepressant use and eclampsia, OR 2.84 (p < 0.0005, CI 2.06 – 3.92), unchanged when compared with the depressed/anxious cohort: OR 2.84 (p < 0.0005, CI 2.06 – 3.92). Conclusions: This study supports existing research suggesting a strong relationship between antidepressant use in pregnancy and hypertensive disorders. Comparison with a depressed/anxious cohort reduces the risk that these underlying conditions could contribute to this finding.