Abstract
OBJECTIVE: This retrospective cohort study investigated relationships between antidepressant use in pregnancy and hypertensive disorders of pregnancy. DESIGN/SETTING/SAMPLE: Observational cohort study examining births in an outer-metropolitan maternity hospital in Australia between 2008-2022. 75,308 births were examined. METHODS: Logistic regression analysis considering covariates including maternal age, smoking, BMI, depression, anxiety, schizophrenia or bipolar disorder, gestational diabetes, pre-pregnancy diabetes. The antidepressant treatment cohort was compared with two groups: all births at this hospital within this time period, and a more closely matched depressed/anxious cohort not treated with antidepressants in pregnancy. The overall group of women taking antidepressants in pregnancy was also compared with women taking antihypertensive medications in pregnancy. MAIN OUTCOME MEASURES: Clinical diagnoses of hypertension, pre-eclampsia or eclampsia recorded in pregnancy, at birth or the immediate postpartum, as well as 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). Considering the co-administration of antidepressants and antihypertensive medications, a strong relationship was found: OR 2.90, p < 0.000, CI 2.13-3.94, aOR 2.02 p < 0.000, CI 1.39-2.93. 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.