A recent study published in BMJ Open has linked antidepressant use and risk of gestational diabetes. The study aimed to determine the association between antidepressant classes, types, and duration of use during pregnancy and the risk of gestational diabetes.

Gestational diabetes poses a significant health risk to pregnant women. The researchers defined it as a carbohydrate intolerance occurring during pregnancy, typically diagnosed between 24 and 28 weeks of pregnancy. Several adverse effects of antidepressants could lead to gestational diabetes, including weight gain, insulin resistance, and glucose metabolism dysregulation.

Studies show that anywhere from 1% to 20% of pregnant women are affected by gestational diabetes worldwide, depending on the population studied and the diagnosis criteria adopted. Furthermore, pregnancies with gestational diabetes are at higher risk of birth complications, and may predispose children to type 2 diabetes and obesity.

The researchers utilized the Quebec Pregnancy Cohort, a Canadian provincial database that includes data on all pregnancies and children in Quebec from January 1998 to December 2015. The cohort is 1 of the major strengths of the study, thanks to its status as one of the largest medico-administrative databases with 17 years of follow-up. 

The researchers identified cases of gestational diabetes after week 20 of pregnancy, and randomly matched them 1:10 to controls on gestational age at index rate and year of pregnancy. Exposure to antidepressants was established based on filled prescriptions between the beginning of pregnancy and index rate.

Among the 20,905 cases and 209,050 matched controls, 4.2% of women were exposed to antidepressants. After adjusting for potential confounders, antidepressant use was associated with an increased risk of gestational diabetes. Specifically, venlafaxine (Effexor XR, Pfizer) and amitriptyline were associated with an increased risk of gestational diabetes.

The risk of developing gestational diabetes was increased with longer duration of antidepressant use, specifically for serotonin norepinephrine reuptake inhibitors, tricyclic antidepressants, and combined use of 2 antidepressant classes. There was no statistically significant association observed for selective serotonin reuptake inhibitors.

The researchers noted that treatment of depression before, during, and after pregnancy is of concern, and untreated depression can lead to relapse during pregnancy and postpartum. They added that adverse outcomes associated with antidepressant use during pregnancy, including gestational diabetes, should be weighed against the risks of nonmedicated depression, and that further research is needed to replicate their findings.


REFERENCE

Dandjinou M, Sheehy O, Berard A. Antidepressant use during pregnancy and the risk of gestational diabetes mellitus: a nested case–control study. BMJ Open 2019;9;e025908. doi:10.1136/bmjopen-2019-025908.