Of the 5,731 women without pre-gestational hypertension, 538 (9.4%) reported being diagnosed with GHT and among these 538 women, 153 (28.4%) developed preeclampsia (2.7% of all subjects). A total of 199 (3.5%) women were using SSRIs two months before conception (191 used these medications for mood disorders); 107 of them discontinued SSRIs before the first trimester (i.e., “discontinuers”), and 92 remained on the medications beyond the first trimester of pregnancy (i.e., “continuers”) (). Most women maintained their exposure status during the later trimesters: 12 (11.0%) of the discontinuers restarted their treatment and 6 (6.5%) of the continuers stopped taking SSRIs.
Antidepressant use in relation to the last menstrual period, Slone Epidemiology Center Birth Defects Study, 1998-2007 *
Maternal characteristics by SSRI use status are shown in . SSRI discontinuers and continuers did not differ substantially in their baseline characteristics. The risk of GHT and/or preeclampsia was associated with region, younger maternal age, White race, lower family income, younger age at menarche, cigarette smoking, diabetes mellitus, higher pre-pregnancy BMI, multiple gestations (twins or more), primigravidae, and history of fertility treatment (data not shown). These variables were included in our final models.
Maternal characteristics by selective serotonin reuptake inhibitor (SSRI) use status, Slone Epidemiology Center Birth Defects Study, 1998-2007 *
Sixty-eight women were using non-SSRI antidepressants two months before pregnancy (16 used serotonin/norepinephrine reuptake inhibitors, SNRIs); 13 of them (19.1%; 3 used SNRIs) developed GHT and 4 (5.9%; 1 used SNRIs) developed preeclampsia. Compared with non-users, the adjusted RR for women who used non-SSRI antidepressants immediately before or during pregnancy was 1.58 (95% CI: 0.90-2.80) for GHT and 1.55 (95% CI: 0.55-4.38) for preeclampsia. Due to small numbers, non-SSRI antidepressant use was not analyzed further, except as a potential confounder.
shows the cumulative incidence of GHT and preeclampsia by SSRI exposure status. SSRI users had a higher risk of GHT, compared with women not exposed to SSRIs; the risk was greater for continuers than for discontinuers (). The increased risk observed among continuers appeared to be largely attributable to preeclampsia, although there was also a suggestion of elevated risk for GHT without preeclampsia. The results were similar when we compared discontinuers who did not restart their treatment with continuers who did not stop using SSRIs during later trimesters. RRs did not vary greatly by gravidity or smoking status; restricting our analyses to singleton births, or using women exposed to SSRIs only (and not to non-SSRI antidepressants concomitantly) did not materially change the results (data not shown). We did not have the power to evaluate specific SSRIs.
Cumulative incidence of gestational hypertension and preeclampsia by selective serotonin reuptake inhibitor (SSRI) use, Slone Epidemiology Center Birth Defects Study, 1998-2007 *
Risks of gestational hypertension with and without pre-eclampsia according to selective serotonin reuptake inhibitor (SSRI) exposure status, Slone Epidemiology Center Birth Defects Study, 1998-2007 *
There were 146 and 35 early-onset GHT and preeclampsia cases, respectively. The RRs for continuers and discontinuers were similar for early- and late-onset GHT compared with non-users. However, comparing continuers with non-users, the RR of early-onset preeclampsia was 16.4 (95% CI: 6.2, 43.7; based on 6 cases among continuers), and the RR of late-onset preeclampsia was 3.5 (95% CI: 1.6, 7.5; 8 cases among continuers). There was no indication of violation of the proportional hazards assumption in any analyses.