By Will Boggs MD
NEW YORK—Using some types of antidepressants during pregnancy is associated with an increased risk of developing gestational diabetes, according to findings from Canada's Quebec Pregnancy Cohort (QPC).
"Depression needs to be treated during pregnancy," Dr. Anick Berard of CHU Sainte-Justine and the University of Montreal told Reuters Health by email. "There are many forms of treatments - antidepressants is one of them. Women should plan their pregnancy and have a discussion on the risks and benefits of treating depression with antidepressants during pregnancy in order to make an informed decision."
Several studies have linked antidepressant use to weight gain, insulin resistance, and glucose metabolism dysregulation, all of which can contribute to an increased risk of diabetes. Evidence linking antidepressant use to gestational diabetes has remained inconclusive.
Dr. Berard's team conducted a nested case-control study within the QPC including 20,905 women with gestational diabetes and 209,050 unaffected women, all with singleton pregnancies.
After adjusting for potential confounding factors, antidepressant use during pregnancy was associated with an overall 19% increased odds of gestational diabetes, compared with nonuse, the researchers report in BMJ Open, online October 1.
Serotonin-norepinephrine-reuptake inhibitors (SNRIs) were associated with 27% increased odds of gestational diabetes, tricyclic antidepressants with 47% increased odds, and combined use of two or more antidepressant classes with 38% increased odds.
Use of selective serotonin-reuptake inhibitors (SSRIs), however, was not significantly associated with an increased risk of gestational diabetes.
Among individual antidepressants, venlafaxine was associated with 27% increased odds of gestational diabetes and amitriptyline with 52% increased odds, whereas citalopram, paroxetine, and sertraline were not significantly associated with gestational diabetes.
Gestational diabetes risk varied with the duration of exposure to antidepressants during pregnancy: 15% increased odds with short duration (90 days or less), 17% increased odds with medium duration (90-180 days), and 29% increased odds with long duration (180 days or more).
Antidepressant use before pregnancy and a history of depression or anxiety were not associated with gestational diabetes risk.
"These increased estimates need to be put in perspective," Dr. Berard said. "The baseline prevalence of gestational diabetes is between 7-9%; hence, a 15% increased risk would result in a prevalence of 10%, whereas a 52% increase would result in a 14% prevalence. Hence, the increases remain small but above what we would have expected."
"If a woman is pregnant and is taking antidepressants, she should not stop by herself but should have an informed discussion with her treating physician to assess the best way forward," she said.
Dr. Paige Wartko of Kaiser Permanente Washington Health Research Institute, in Seattle, recently found no overall increased risk of gestational diabetes with continuation of antidepressant use in pregnancy in a retrospective study. She told Reuters Health by email, "Although this is an important study, the findings do not warrant a change in practice at this point, given the relatively small elevated risk and potential for bias or chance to explain the results."
"Additionally," said Dr. Wartko, who was not involved in the new research, "neither of the specific antidepressant medications that were associated with greater risk of gestational diabetes in this study (venlafaxine and amitriptyline) are considered first-line treatment for depression in pregnant women, meaning that most pregnant women using antidepressants do not use these medications."
"Physicians should interpret the findings while keeping the limitations of the study in mind and continuing to balance the risks and benefits of pharmacologic treatment of depression and anxiety in pregnancy," she said. "The mental health of the woman is paramount both for her own well-being and for the baby."
Dr. Wartko added, "Of course, potential risks must also be considered, including congenital defects, preterm birth, and neurodevelopmental outcomes, along with gestational diabetes. For women whose depression or anxiety is well-controlled, it is reasonable to try discontinuing their antidepressant, but they should be closely monitored in case of relapse. Non-pharmacologic treatment, such cognitive behavioral therapy or other forms of counseling, also can be a good option for women during pregnancy."
BMJ Open 2019.
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