Is There Any Association Between Use of Antidepressants and Preeclampsia or Gestational Hypertension? A Systematic Review of Current Studies

Objective: Hypertension in pregnant women is an important medical problem, which can cause morbidity and mortality in the fetus. This study reviewed the current literature examining the potential relationship between use of antidepressants during pregnancy and preeclampsia or gestational hypertension. Methods: PubMed was searched for English-language reports between January 1, 1995, and December 31, 2015, by using combinations of key words pregnancy, pregnancy complications, preeclampsia, gestational hypertension, and antidepressants. Studies that reported the diagnosis of preeclampsia or gestational hypertension and use of antidepressant were included in the review. Results: A total of 7 relevant studies that met the review criteria were examined. The studies reported that compared with nonusers adjusted relative risk of preeclampsia or gestational hypertension in antidepressant users was 1.28 to 1.53 for any antidepressant, 1.05 to 3.16 for selective serotonin reuptake inhibitors, 1.49 to 1.95 for selective serotonin-norepinephrine reuptake inhibitors, and 0.35 to 3.23 for tricyclic antidepressants. Consistently, antidepressant use during the second trimester of pregnancy was associated with increased risk of preeclampsia or gestational hypertension. However, possible contribution of severity, type, and comorbidity of underlying anxiety or depressive disorders is unclear in the current studies. Conclusions: Although some studies have suggested a moderately increased risk in pregnancy-specific hypertensive disorders with antidepressant treatment, the current data do not allow a definitive conclusion on this topic, because the studies have many methodological limitations. In addition, the effects of untreated depression or anxiety disorders cannot be disentangled from the results.