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Pharmacoepidemiol Drug Saf. 2019 Sep;28(9):1194-1203. doi: 10.1002/pds.4799. Epub 2019 Jul 12.

Antidepressant continuation in pregnancy and risk of gestational diabetes.

Author information

1
Department of Epidemiology, University of Washington, Seattle, Washington.
2
Kaiser Permanente Washington Health Research Institute, Seattle, Washington.
3
Department of Biostatistics, University of Washington, Seattle, Washington.
4
Department of Obstetrics & Gynecology, University of Washington, Seattle, Washington.
5
Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.

Abstract

PURPOSE:

Previous studies observed modestly higher risk of gestational diabetes (GDM) associated with antidepressant use in pregnancy, potentially due to confounding by indication. We assessed the association of antidepressant continuation in pregnancy with GDM, as well as blood glucose levels, after accounting for confounding.

METHODS:

We conducted a retrospective cohort study of singleton live births from 2001 to 2014 to women enrolled in Kaiser Permanente Washington, an integrated health care delivery system, utilizing electronic health data and linked Washington State birth records. We required that women have ≥1 antidepressant prescription fills ≤6 months before pregnancy. Women with an antidepressant fill during pregnancy were categorized as "continuers" (n = 1634); those without a fill were "discontinuers" (n = 1211). We calculated relative risks (RRs) for GDM and mean differences in screening blood glucose levels using generalized estimating equations with inverse probability of treatment weighting to account for baseline characteristics, including mental health conditions and indicators of mental health severity.

RESULTS:

Compared with discontinuers, antidepressant continuers had comparable risk of GDM (RR: 1.10; 95% confidence interval [CI], 0.84-1.44) and blood glucose levels (mean difference: 2.3 mg/dL; 95% CI, -1.5 to 6.1 mg/dL). We observed generally similar results for specific antidepressants, with the potential exceptions of risk of GDM associated with sertraline (RR: 1.30; 95% CI, 0.90-1.88) and venlafaxine (RR: 1.52; 95% CI, 0.87-2.68), but neither association was statistically significant.

CONCLUSIONS:

Our study suggests that overall, women who continue antidepressants in pregnancy are not at increased risk for GDM or higher blood glucose, although further study may be warranted for sertraline and venlafaxine.

KEYWORDS:

antidepressants; blood glucose levels; gestational diabetes; glucola; oral glucose challenge test; pharmacoepidemiology; pregnancy

PMID:
31298445
PMCID:
PMC6728166
[Available on 2020-09-01]
DOI:
10.1002/pds.4799

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