Montreal—Expectant mothers who take specific antidepressants appear to have a higher risk of developing gestational diabetes, according to a new Canadian study.

The report in BMJ Open advises that the risk was greatest among pregnant women using the serotonin and norepinephrine reuptake inhibitor (SNRI) venlafaxine and amitriptyline, which belongs to the older, tricyclics class of antidepressants.

Gestational diabetes, which affects about 20% of pregnancies worldwide, can lead to overweight infants and prolonged labor. Offspring have higher risks of obesity, type 2 diabetes, and cardiovascular disease.

CHU Sainte Justine–lead researchers suggest that previous studies looking at the potential link between antidepressant use and gestational diabetes risk have provided inconclusive results and been hampered by study design.

The study team sought to determine the association between antidepressant (AD) classes, types, and duration of use during pregnancy and the risk of gestational diabetes mellitus (GDM). To do that, the investigators conducted a nested case-control study within the Quebec Pregnancy Cohort (QPC), a Canadian provincial database that includes data on all pregnancies and children in Quebec from January 1998 to December 2015.

Patients with GDM, the primary outcome, were identified after Week 20 of pregnancy and randomly matched 1:10 to controls on gestational age at index and year of pregnancy. Exposure to antidepressants was assessed by filled prescriptions between the beginning of pregnancy (first day of last menstrual period) and index date.

Results indicate that, among 20,905 cases and 209,050 matched controls, 4.2% of women were exposed to ADs. When adjusting for potential confounders, researches determined that AD use was associated with an increased risk of GDM (adjusted odds ration [aOR] 1.19, 95% CI, 1.08-1.30). They report that venlafaxine (aOR 1.27, 95% CI, 1.09-1.49) and amitriptyline (aOR 1.52, 95% CI, 1.25-1.84) were also associated with an increased risk of GDM.

The study also emphasizes that risk of GDM was increased with longer duration of AD use, specifically for serotonin norepinephrine reuptake inhibitors, tricyclic ADs, and combined use of two AD classes.

On the other hand, no statistically significant association was observed for selective serotonin reuptake inhibitors.

“The findings suggest that ADs—and specifically venlafaxine and amitriptyline—were associated with an increased risk of GDM,” study authors conclude, adding that a 27% heightened risk was linked to venlafaxine and a 52% heightened risk was linked to amitriptyline.

The study points out that taking any of those drugs was associated with a 19% heightened risk of being diagnosed with the condition versus not taking ADs during pregnancy. Short-term use was associated with a 15% heightened risk; medium-term use was associated with a 17% heightened risk; and long-term use with a 29% heightened risk, according to the authors.

Researchers caution that the risks and benefits of taking antidepressants during pregnancy need to be weighed up carefully, according to the researchers, who caution, “The treatment of depression is a major concern and is challenging because depression is prevalent before and during pregnancy, and untreated depression can lead to relapse during pregnancy and in the [period immediately after birth].”

 « Click here to return to Weekly News Update.