Depression, Antidepressants and Hypertensive Disorders of Pregnancy: A Systematic Review

Author(s): Sabrina Youash*, Verinder Sharma.

Journal Name: Current Drug Safety

Volume 14 , Issue 2 , 2019

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Graphical Abstract:


Abstract:

Background: Hypertensive disorders of pregnancy including gestational hypertension, preeclampsia and eclampsia are conditions that cause significant perinatal and maternal morbidity and mortality.

Objective: This is a systematic review of the current evidence examining the relationship between both depression and antidepressants on pregnancy-related hypertensive conditions.

Methods: In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol, six databases were searched for articles published between January 1990 and December 2017 (PubMed, Embase, PsycINFO, Cochrane Database of Systematic Reviews, MEDLINE and ClinicalTrials. gov). Randomized control trials, cohort studies and case-control studies were included in this review. Studies that measured the following exposures were included: Antidepressant exposure or diagnosis of depression. Studies that measured the following outcomes were included: Gestational hypertension, preeclampsia or eclampsia. A combination of keywords, as well as Medical Subject Headings (MeSH) index terms, was used for three general categories: antidepressants, depression and hypertensive disorders of pregnancy. A total of 743 studies were identified and 711 were excluded based on relevance to the research question. Twenty studies were included in the final systematic review.

Results: Of the twenty relevant studies, ten specifically examined the relationship between depression and hypertension in pregnancy. Only two of these did not find a significant association. Of the ten studies that concentrated on antidepressant medications, all except one found an association with hypertension in pregnancy to varying degrees.

Conclusion: Review of the literature suggests a possible association between depression and antihypertensive medications with pregnancy-related hypertension, but further studies are needed.

Keywords: Hypertension, pregnancy-induced, preeclampsia, major depressive disorder, vascular diseases, endothelial damage.

[1]
Magee LA, Pels A, Helewa M, et al. Diagnosis, evaluation, and management of the hypertensive disorders of pregnancy: Executive summary. J Obstet Gynaecol Can 2014; 36(5): 416-38.
[2]
Spiegler J, Stichtenoth G, Weichert J. Pregnancy risk factors for very premature delivery: What role do hypertension, obesity and diabetes play? Arch Gynecol Obstet 2013; 288(1): 57-64.
[3]
Leeman L, Dresang LT, Fontaine P. Hypertensive disorders of pregnancy. Am Fam Physician 2016; 93(2): 121-7.
[4]
Joynt KE, Whellan DJ, Connor CMO. Depression and cardiovascular disease: Mechanisms of interaction. Biol Psychiatry 2003; 54(3): 248-61.
[5]
Hu R, Li Y, Zhang Z, Yan W. Antenatal depressive symptoms and risk of preeclampsia or operative deliveries: A meta-analysis. PLoS One 2015; 10(3): e0119018.
[6]
Wallis AB, Saftlas AF. Is there a relationship between prenatal depression and preeclampsia? Am J Hypertens 2009; 22(4): 345-6.
[7]
Thombre MK, Talge NM, Holzman C. Association between pre-pregnancy depression/anxiety symptoms and hypertensive disorders of pregnancy. J Womens Health 2015; 24(3): 228-36.
[8]
Gadot Y, Koren G. The use of antidepressants in pregnancy: Focus on maternal risks. J Obstet Gynaecol Can 2015; 37(1): 56-63.
[9]
Uguz F. Is there any association between use of antidepressants and preeclampsia or gestational hypertension? J Clin Psychopharmacol 2017; 37(1): 72-7.
[10]
Nicholson L, Lecour S, Wedegartner S, Kindermann I, Bohm M, Sliwa K. Assessing perinatal depression as an indicator of risk for pregnancy-associated cardiovascular disease. Cardiovasc J Afr 2016; 27(2): 119-22.
[11]
Bergink V, Laursen TM, Johannsen BMW, Kushner SA, Meltzer-Brody S, Munk-Olsen T. Pre-eclampsia and first-onset postpartum psychiatric episodes: A Danish population-based cohort study. Psychol Med 2015; 45(16): 3481-9.
[12]
Kurki T, Hiilesmaa V, Raitasalo R, Mattila H, Ylikorkala O. Depression and anxiety in early pregnancy and risk for preeclampsia. Obstet Gynecol 2000; 95(4): 487-90.
[13]
Vollebregt KC, van der Wal MF, Wolf H, Vrijkotte TGM, Boer K, Bonsel GJ. Is psychosocial stress in first ongoing pregnancies associated with pre-eclampsia and gestational hypertension? BJOG 2008; 115(5): 607-15.
[14]
Avalos LA, Chen H, Li DK. Antidepressant medication use, depression and the risk of preeclampsia. CNS Spectr 2015; 20(1): 39-47.
[15]
Newport DJ, Hostetter AL, Juul SH, Porterfield SM, Knight BT, Stowe ZN. Prenatal psychostimulant and antidepressant exposure and risk of hypertensive disorders of pregnancy. J Clin Psychiatry 2016; 77(11): 1538-45.
[16]
Dubovicky M, Belovicova K, Csatlosova K, Bogi E. Risks of using SSRI/SNRI antidepressants during pregnancy and lactation. Interdiscip Toxicol 2017; 10(1): 30-4.
[17]
Alder J, Fink N, Bitzer J, Hosli I, Holzgreve W. Depression and anxiety during pregnancy: A risk factor for obstetric, fetal and neonatal outcome? A critical review of the literature. J Matern Fetal Neonatal Med 2007; 20(3): 189-209.
[18]
Osborne LM, Monk C. Perinatal depression - The fourth inflammatory morbidity of pregnancy? Theory and literature review. Psychoneuroendocrinology 2013; 38(10): 1929-52.
[19]
Grigoriadis S. VonderPorten EH, Mamisashvili L, et al. The impact of maternal depression during pregnancy on perinatal outcomes: A systematic review and meta-analysis. J Clin Psychiatry 2013; 74(4): e321-41.
[20]
Moher D, Liberati A, Tetzlaff J, Altman DG. The PRISMA Group Preferred reporting items for systematic reviews and Meta-analyses: The PRISMA Statement. Br Med J 2009; 339: b2535.
[21]
Canadian Task Force on Preventive Health Care. New grades for recommendations from the Canadian Task Force on Preventive Health Care. CMAJ 2003; 169: 207-8.
[22]
Kharaghani R, Geranmaye M, Janani L, et al. Preeclampsia and depression: A case-control study in Tehran. Arch Gynecol Obstet 2012; 286(1): 249-53.
[23]
Winkel S, Einsle F, Pieper L, Hofler M, Wittchen H-U, Martini J. Associations of anxiety disorders, depressive disorders and weight with hypertension during pregnancy. Arch Women Ment Health 2015; 18(3): 473-83.
[24]
Cripe SM, Frederick IO, Qiu C, Williams MA. Risk of preterm delivery and hypertensive disorders of pregnancy in relation to maternal comorbid mood and migraine disorders during pregnancy. Paediatr Perinat Epidemiol 2011; 25(2): 116-23.
[25]
Cetin O, Ozdemir PG, Kurdoglu Z, Hanim SG. Investigation of maternal psychopathologic symptoms, dream anxiety and insomnia in preeclampsia. J Matern Fetal Neonatal Med 2017; 30(20): 2510-5.
[26]
Bansil P, Kuklina EV, Meikle SF, et al. Maternal and fetal outcomes among women with depression. J Womens Health 2010; 19(2): 329-34.
[27]
Palmsten K, Huybrechts KF, Michels KB, et al. Antidepressant use and risk of preeclampsia. Epidemiology 2013; 25(5): 682-91.
[28]
Palmsten K, Setoguchi S, Margulis AV, Patrick AR, Hernandez-Diaz S. Elevated risk of preeclampsia in pregnant women with depression: Depression or antidepressants? Am J Epidemiol 2012; 175(10): 988-97.
[29]
Toh S, Mitchell AA, Louik C, Werler MM, Chambers CD, Hernandez-Diaz S. Selective serotonin reuptake inhibitor use and risk of gestational hypertension. Am J Psychiatry 2009; 166(3): 320-8.
[30]
De Vera MA, Berard A. Antidepressant use during pregnancy and the risk of pregnancy induced hypertension. Br J Clin Pharmacol 2012; 74(2): 362-9.
[31]
Malm H, Sourander A, Gissler M, et al. Pregnancy complications following prenatal exposure to SSRIs or maternal psychiatric disorders: Results from population-based nation register data. Am J Psychiatry 2015; 172(12): 1224-32.
[32]
De Ocampo MPG, Araneta MRG, Macera CA, Alcaraz JE, Moore TR, Chambers CD. Risk of gestational hypertension and preeclampsia in women who discontinued or continued antidepressant medication use during pregnancy. Arch Women Ment Health 2016; 19(6): 1051-61.
[33]
Qiu C, Williams MA, Calderon-Margalit R, Cripe SM, Sorensen TK. Preeclampsia risk in relation to maternal mood and anxiety disorders diagnosed before or during early pregnancy. Am J Hypertens 2009; 22(4): 397-402.
[34]
Lupattelli A, Wood M, Lapane K, Spigset O, Nordeng H. Risk of preeclampsia after gestational exposure to serotonin reuptake inhibitors and other antidepressants: A study from the Norwegian Mother and Child Cohort Study. Pharmacoepidemiol Drug Saf 2017; 26(10): 1266-76.
[35]
Katon WJ, Russo JE, Melville JL, Katon JG, Gavin AR. Depression in pregnancy is associated with pre-existing but not pregnancy-induced hypertension. Gen Hosp Psychiatry 2012; 34(1): 9-16.
[36]
Zakiyah N, ter Heijne LF, Bos JH, Hak E. POstma MJ, Schuiling-Veninga CCM. Antidepressant use during pregnancy and the risk of developing gestational hypertension: A retrospective cohort study. BMC Pregnancy Childbirth 2018; 18: 187.
[37]
Lynskey MT. The comorbidity of alcohol dependence and affective disorders: Treatment implications. Drug Alcohol Depend 1998; 52(3): 201-9.
[38]
Wong S, Ordean A, Kahan M, et al. Substance use in pregnancy. J Obstet Gynaecol Can 2011; 33(4): 367-84.
[39]
Alberti KG, Zimmet P, Shaw J. IDF Epidemiology Task Force Consensus Group The metabolic syndrome – a new worldwide definition. Lancet 2005; 366(9491): 1059-62.


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Article Details

VOLUME: 14
ISSUE: 2
Year: 2019
Page: [102 - 108]
Pages: 7
DOI: 10.2174/1574886314666190121144711
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