TOPLINE:

Serotonin-norepinephrine reuptake inhibitors (SNRI) increase the risk for hypertensive disorders of pregnancy (HDP) by 80% compared with selective serotonin reuptake inhibitors (SSRI) in pregnant women with depression or anxiety. Among 3471 eligible pregnancies, venlafaxine showed a 58% higher risk for hypertensive disorders than sertraline.

METHODOLOGY:

• Researchers conducted a cohort study using data from the Quebec Pregnancy Cohort between 1998 and 2015, with follow-up starting at 20 weeks of gestation.
• Analysis included 3471 pregnant women with depression or anxiety, comprising 2411 (69.5%) exposed to SSRI and 1060 (30.5%) to SNRI at 20 weeks of gestation.
• Participants were followed until diagnosis of gestational hypertension, preeclampsia, or eclampsia; follow-up ended at delivery, discontinuation of SSRI or SNRI, or December 31, 2015.
• Cox proportional hazards models were used to estimate adjusted hazard ratios with 95% CIs, comparing SNRI exposure with SSRI exposure.

TAKEAWAY:

• SNRI use in late pregnancy was associated with an increased risk for hypertensive disorders compared with SSRIs (adjusted hazard ratio [aHR], 1.80; 95% CI, 1.37-2.35).
• Venlafaxine specifically showed elevated risk compared with sertraline (aHR, 1.58; 95% CI, 1.04-2.40), while all SSRIs had similar risk profiles.
• Sensitivity analyses revealed increased risks for both gestational hypertension (aHR, 1.91; 95% CI, 1.34-2.73) and preeclampsia or eclampsia (aHR, 1.78; 95% CI, 1.25-2.53) with SNRI use.
• According to the authors, these findings align with evidence supporting norepinephrine-mediated increase in vascular tone associated with SNRIs.

IN PRACTICE:

“These findings align with evidence supporting the norepinephrine-mediated increase in vascular tone associated with SNRIs and reinforce the role of pharmacologic mechanisms in HDP development, considering the effect of underlying depression,” wrote the authors of the study. “When antidepressant therapy is indicated during pregnancy, SSRIs may represent the lower-risk alternative,” they added.

SOURCE:

The study was led by Anick Bérard, PhD, Research Center, Sainte-Justine Hospital, Montreal, Quebec, Canada. It was published online in the American Journal of Obstetrics and Gynecology.

LIMITATIONS:

SNRI users were comparable to SSRI users except that they had fewer visits to psychiatrists in the year before pregnancy, which could indicate differences in disease severity or management patterns that might influence outcomes.

DISCLOSURES:

Bérard disclosed serving as a consultant for plaintiffs in litigations on antidepressants between 2012 and 2018. The remaining authors reported having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.