Use of antidepressants during pregnancy and the risk of pregnancy-induced hypertension

Van Loveren, F. MAM., Boekema, M., Hak, E., Bos, J. HJ., Aarnoudse, J. G. & Schuiling-Veninga, C. CM., 1-Oct-2014, In : Pharmacoepidemiology and Drug Safety. 23, S1, p. 167 1 p.

Research output: Contribution to journalMeeting AbstractAcademic

Background: Pregnancy-induced hypertension (PIH) is possibly caused by an increased activity of the sympatic nervous system. Previous studies have suggested that inhibition of the re-uptake of serotonin and norepinephrine by selective serotonin re-uptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) could contribute to this increased activity. Objectives: To assess the association between the use of antidepressants (ADs) and the development of pregnancyinduced hypertension. Methods: Using the prescription database we conducted a case-control study among pregnant women between 1995 and 2012. Cases were defined as>1 dispensed prescription of an antihypertensive drug (methyldopa, dihydralazine, ketanserin, labetalol, nifidepine) after 20weeks of gestation. Controls were matched for age at time of giving birth. Only first and singleton pregnancies of women not using any antihypertensive drug during 6months before pregnancy till 20weeks of gestation were included. Exposure was defined as>1 dispensed prescription of an antidepressant during pregnancy. Logistic regression analysis was used to estimate odds ratios (OR) and their corresponding 95% confidence intervals (95% CIs). Subanalyses were conducted for class of AD (TCA, SSRI, other) and duration of AD use (1-30, ≥ 31 Defined Daily Doses (DDDs)). As the exact duration of gestation was unknown, all analysis were conducted for 3 theoretical gestational ages (36, 38, 40weeks). Results: A total of 312 PIH cases and 12480 controls were included in the analysis (gestational age 36 weeks). The exposure rate among case and control pregnancies was 3.2% and 1.5% respectively. The use of AD increased the risk for developing PIH more than twice (OR [95% CI] 2.24 [1.17-4.27]). Significant associations (OR [95% CI]) were also found for the subgroups TCA (3.39 [1.04-11.08]), SSRI (2.23 [1.03-4.81]) and ≥ 31 DDDs (2.38 [1.16-4.90]). Increasing the theoretical gestational age showed comparable results. Conclusions: Prolonged use of ADs during pregnancy appeared to be associated with an increased risk of developing PIH. When balancing the benefit and risks of using these drugs during pregnancy, this should be taken into account.
Original languageEnglish
Pages (from-to)167
Number of pages1
JournalPharmacoepidemiology and Drug Safety
Issue numberS1
Publication statusPublished - 1-Oct-2014


  • antidepressant agent, antihypertensive agent, serotonin, noradrenalin, serotonin uptake inhibitor, methyldopa, labetalol, ketanserin, dihydralazine, tricyclic antidepressant agent, pregnancy, risk, maternal hypertension, pharmacoepidemiology, risk management, prescription, human, gestational age, exposure, female, pregnant woman, case control study, confidence interval, logistic regression analysis, data base, hypertension, nervous system

ID: 14307395