(204) Risk of Gestational Hypertension in Women Treated with Serotonin and Norepinephrine Reuptake Inhibitors: A Comparative Study in The EFEMERIS Database

Publication Number: 535

Background: Depressive disorders are relatively common during pregnancy and mainly treated with antidepressants inhibiting serotonin (SSRI) or serotonin and noradrenaline- (SNRI) recapture. In the general population, the use of such antidepressants has been associated with pressor effects. Gestational hypertension (GHTA), a new onset of arterial hypertension after 20 weeks of gestation is a leading cause of maternal and infant morbidity and mortality. The aim of this study was to evaluate a possible association between exposure to SNRI during pregnancy and GHTA.

Objectives: The aim of this study was to evaluate a possible association between exposure to SNRI during pregnancy and GHTA.

Methods: EFEMERIS database was used; it contains medications dispensed to pregnant women in Haute-Garonne between July 2004 and December 2019. We identified women with GHTA using antihypertensive medication after 20 weeks of gestation, hospitalization for GHTA, mention of GHTA on children compulsory health certificates or on pregnancy termination records. We compared women exposed to SNRIs to women using SSRIs and to unexposed controls. Univariate then multivariate logistic regressions have been conducted.

Results: The study included 308 pregnancies (0.2%) exposed to SNRIs, 1,627 (1.1%) to SSRIs and 144,580 (98.7%) unexposed pregnant women. Women exposed to SNRI or SSRI had more long-term health conditions (12.5% and 11.3% versus 2.1%), had been more exposed to potentially hypertensive medications during pregnancy (19.5% and 20.7% versus 12.7%) and have been prescribed a higher average number of active substances than those not exposed (13.9 versus 8.9). The rate of women with GHTA was higher among women exposed to SNRIs (9.1%) compared to women exposed to SSRIs (5.4%) (ORa=1.82[1.16-2.87]) and those not exposed (4.3%) (ORa=2.21[1.48-3.29]).

Conclusions: This study indicates an increased risk of GHTA in women treated with SNRI. The observed effect needs to be further investigated. However, it is in line (1) with the pharmacological profile of these antidepressants which increase the level of noradrenaline (a pressive catecholamine) and (2) with previously described adverse effects in treated patients.