March 22, 2012

expert reaction to study of antidepressants and hypertension in pregnancy

A study in the British Journal of Clinical Pharmacology suggested that use of SSRI antidepressants during pregnancy was linked with increased risk of pregnancy-induced high blood pressure. The SMC sent out comments and a before the headlines analysis.

Carmine Pariante, Professor of Biological Psychiatry and Head of the Sections of Perinatal Psychiatry & Stress, Psychiatry and Immunology, Institute of Psychiatry, Kings College London, said:

“The findings in this paper do not introduce any novel or particularly worrying findings, and pregnant women should not stop taking antidepressant medications just because of this paper.

“Antidepressants are like any other drugs – they have side effects, and these need to be taken into consideration when appraising their risks and benefits. Antidepressants are used to treat depression, a disabling mental health problem that is very common during pregnancy.

“Depression during pregnancy, if left untreated, has profound negative effects on both mothers and babies. For example, being depressed during pregnancy shortens the duration of the pregnancy and leads to smaller babies at birth, an effect equivalent to smoking 10 cigarettes a day for the whole of the pregnancy. Moreover, depression during pregnancy can go on to continue as postpartum depression, compromising the quality of those precious first weeks of mother-child relationship.

“Finally, longitudinal studies have shown that children of mothers who were depressed during pregnancy are at higher risk of developing depression and other mental health problems themselves when they become adolescents or adults.

“Against these studies showing the negative effects of untreated depression, there is now accumulating evidence, including that in this study, that using antidepressants in pregnancy increases the risk of some adverse effects. On average, these increases in risk are small, but clearly women should always discuss the pros and cons of using any medication during pregnancy with their doctors.

“However, pregnant women should not stop taking antidepressant medications. What women – and all health professionals – should do is ask the government to fund mental health services and psychological therapies for women who are pregnant, enabling the treatment of depression and supporting women, when possible, without antidepressants.”

Dr Alexander Heazell, Clinical Lecturer in Obstetrics at Manchester Academic Health Science Centre, said:

“Women who are taking prescribed antidepressants during pregnancy should not cease their medication on the basis of this research.

“Further research is needed to determine which type of antidepressants might be linked to hypertensive disorders of pregnancy, and whether their use was actually associated with significant deleterious effects on maternal and foetal health.

“This study does provide an interesting link between antidepressant medication currently used in pregnancy and hypertensive disorders including pre-eclampsia and pregnancy-induced hypertension. This link is relatively modest, although there is a 50% increase in hypertensive disorders of pregnancy, the lower limit of the 95% confidence interval is only just above 1.

“The research is weakened by combining all hypertensive disorders of pregnancy together as they have markedly different outcomes for mother and baby. For example, preterm pre-eclampsia is associated with foetal growth restriction and maternal medical complications, whereas pregnancy-induced hypertension is associated with slightly larger babies.

“The research also does not adjust for ethnicity which may be an important factor. Women from some ethnic groups are more prone to hypertension in pregnancy and mental health problems.”

‘Antidepressant Use During Pregnancy and the Risk of Pregnancy Induced Hypertension’ by De Vera, M. et al., published in British Journal of Clinical Pharmacology on Thursday 15th March. Before The Headlines analysis: Antidepressant Use During Pregnancy and the Risk of Pregnancy Induced Hypertension. Before The Headlines is a service provided to the SMC by volunteer statisticians: members of the Royal Statistical Society and Statisticians in the Pharmaceutical Industry. A list of contributors, including affiliations, is available here.