Antidepressants linked to heightened pregnancy related diabetes risk: BMJ

Canada: The use of antidepressants specifically venlafaxine and amitriptyline increase the risk of gestational diabetes mellitus (GDM), according to a recent case-control study in the BMJ Open journal.

Blood sugar may increase during pregnancy usually in the second or third trimester and may give rise to gestational diabetes that usually disappears after giving birth to the child. GDM occurs in about 7 percent of all pregnancies. It usually arises in the second half of pregnancy and goes away as soon as the baby is born.

The study is significant as the use of antidepressants by pregnant women is common and neurotransmitters such as serotonin, norepinephrine and dopamine are the mainstay of their action.

The previous studies have evaluated the potential risk between antidepressant use and gestational diabetes risk but the results were proven to be inconclusive.

Previous research looking at the potential link between antidepressant use and gestational diabetes risk has proved inconclusive and has been hampered by study design, say the researchers.

Maëlle Dandjinou, Research Center, CHU Sainte-Justine, Montreal, Quebec, Canada, and colleagues determined the association between antidepressant (AD) classes, types and duration of use during pregnancy and the risk of GDM.

The researchers drew on information from the Quebec Pregnancy Cohort, which incorporates three Canadian databases, and includes all pregnancies and children born in Quebec between 1998 and 2015.

Each case of gestational diabetes (20,905), identified after 20 weeks of pregnancy, was randomly matched with 10 unaffected pregnancies (209,050) of the same age and calendar year of delivery.

Antidepressant use was assessed using the information on prescriptions filled for these drugs between the start of pregnancy and the diagnosis of gestational diabetes. In all, 9741 (just over 4%) of the mums took antidepressants, singly or combined. These included citalopram, fluoxetine, fluvoxamine, paroxetine and sertraline, which belong to a class of drugs known as selective serotonin reuptake inhibitors, or SSRIs for short; venlafaxine; and amitriptyline.

After taking account of potentially influential factors, such as the mum’s age, welfare assistance, area of residence and other underlying conditions, taking antidepressants during pregnancy was associated with a heightened risk of developing gestational diabetes.

Key findings of the study include:

• When adjusting for potential confounders, AD use was associated with an increased risk of GDM; venlafaxine and amitriptyline were also associated with an increased risk of GDM.


• The 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.


• No statistically significant association was observed for selective serotonin reuptake inhibitors.

The authors found that antidepressant use can affect blood sugar control or glucose homeostasis, pancreatic insulin secretion, cellular insulin resistance, and weight. They conclude: "Adverse outcomes associated with [antidepressant] use during pregnancy including [gestational diabetes] should be weighed against the consequences of non-medicated depression, especially for women with severe depression."

But the pros and cons of taking antidepressants during pregnancy need to be weighed up carefully, caution the researchers, particularly for women whose depression is severe.

“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],” they write.

To read the complete study follow the link: http://dx.doi.org/10.1136/bmjopen-2018-025908