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Hypertension in pregnancy is typically outlined as a diastolic blood stress of 90 mm Hg or higher or a systolic pressure at or previously mentioned 140 mm Hg. Preeclampsia is defined as the progress of hypertension alongside with proteinuria or edema for the duration of pregnancy, frequently in the second 50 % of gestation. Preeclampsia is far more typical in gals who have not carried a former pregnancy outside of 20 weeks and in girls at both severe of their reproductive a long time.
Exactly what triggers preeclampsia is not fully recognized. Due to the fact serotonin performs a job in vascular function and the regulation of blood force, some have questioned irrespective of whether the use of serotonin reuptake inhibitor (SRI) antidepressants may well have an affect on a woman’s possibility for hypertension or preeclampsia. Even though numerous observational experiments have indicated an increased threat of hypertension and/or preeclampsia in women having SRIs in the course of being pregnant, this locating is not reliable, and most of these experiments have been smaller and have not been ready to account for likely confounding variables.
Meta-Examination: SSRIs and Possibility for Hypertension and Preeclampsia
To greater estimate the risk of gestational hypertension and preeclampsia in females using SSRI antidepressants throughout being pregnant, Gumusoglu and colleagues executed a meta-examination of observational cohort or populace scientific tests of females who utilized SSRIs through pregnancy, selecting reports that specifically dealt with the concern of regardless of whether gestational SSRI use modulates risk of preeclampsia and/or gestational hypertension. The last analysis bundled 9 scientific studies released in between 2009 and 2020, like around 40,000 SSRI-uncovered pregnancies.
Between the 9 bundled research, two evaluated danger of gestational hypertension and seven evaluated threat of preeclampsia. Of the nine experiments assessed, 3 claimed a statistically substantial improve in danger of gestational hypertension or preeclampsia in SSRI-exposed pregnancies. Four experiments claimed a non-considerable enhance in risk of preeclampsia or gestational hypertension with SSRI use all through being pregnant. The pooled relative risk (RR) of gestational hypertension or preeclampsia was 1.43 (95 % CI: 1.15–1.78, P < 0.001).
While this meta-analysis does show a small, statistically significant association between prenatal SSRI exposure and risk of gestational hypertension or preeclampsia, the authors note some important limitations of this meta-analysis. Most importantly, most of the studies included in the meta-analysis failed to account for anxiety/depression severity, SSRI dose, and/or other well-defined preeclampsia risk factors (e.g., obesity, diabetes, smoking, race). The most common limitation of the included studies was the failure to account for anxiety/depression severity in the mother, which may independently drive risk for gestational hypertension and/or preeclampsia.
The Link Between Depression and Preeclampsia
Gumusoglu and colleagues note that women who use SSRIs in pregnancy may have increased risk for preeclampsia simply because they also have more severe depressive illness, which has been identified as an independent preeclampsia risk factor in other studies (Qiu et al, 2007). In fact, they note that when specific dimensions of maternal mental health are accounted for, the relative risk for preeclampsia among SSRI users is not significant, as observed in the study from Palmsten and colleagues (RR 1.16, 95 % CI 0.92–1.45). Similarly, after accounting for lifetime major depressive episodes, SSRI use in early and mid-pregnancy does not significantly increase preeclampsia risk (Lupattelli et al, 2017). Making the analysis of this association even more complicated is the fact that several preeclampsia risk factors (including obesity, metabolic syndrome, and cardiovascular disease) are more common in women with depression.
Is it Possible that SSRIs May Actually Decrease Risk for Preeclampsia
While this meta-analysis does show a small, statistically significant association between prenatal SSRI exposure and risk of gestational hypertension or preeclampsia, there are important limitations to consider. Most studies fail to account for well-defined preeclampsia risk factors (e.g., obesity, diabetes, smoking, race). Furthermore, there is increasing evidence to indicate that anxiety and/or depression in the mother may independently drive risk for gestational hypertension and/or preeclampsia.
It is biologically plausible that SRIs may actually decrease risk for preeclampsia. Both depression and preeclampsia are associated with dysregulation of serotonergic neurotransmitter systems thus, it is plausible that medications, such as SRI antidepressants, that improve serotonergic regulation may also help to decrease depressive symptoms, as well as decrease vulnerability to preeclampsia. In an upcoming post, we will discuss a preliminary study that supports this hypothesis. Stay tuned.
While future studies will help to clarify the complex interaction between depression, SSRI treatment and pre-eclampsia, the information we have thus far is reassuring. If there is a risk of preeclampsia associated with SSRI treatment, the risk appears to be relatively small. However, there is considerable data to indicate that risk of preeclampsia is higher in women with depressive illness (even in the absence of treatment with an SSRI) and may be affected by other co-occurring risk factors, such as obesity, chronic hypertension, diabetes mellitus, and smoking.
Ruta Nonacs, MD PhD
Lupattelli A, Wood M, Lapane K, Spigset O, Nordeng H. Risk of preeclampsia after gestational exposure to selective serotonin reuptake inhibitors and other antidepressants: A study from The Norwegian Mother and Child Cohort Study. Pharmacoepidemiol Drug Saf. 2017 Oct 26(10):1266-1276.
Palmsten K, Setoguchi S, Margulis AV, Patrick AR, Hernández-Díaz S. Elevated risk of preeclampsia in pregnant women with depression: depression or antidepressants? Am J Epidemiol. 2012 May 15175(10):988-97.
Qiu C, Sanchez SE, Lam N, Garcia P, Williams MA: Associations of depression and depressive symptoms with preeclampsia: results from a Peruvian case-control study. BMC Womens Health 2007 7:15.