- A new study finds that pregnant women taking certain types of antidepressants were anywhere from a 15 to 52 percent higher risk for developing gestational diabetes.
- But selective serotonin reuptake inhibitor (SSRI) drugs were not among the types of antidepressants that increased risk.
- The study joins a growing body of evidence linking these forms of antidepressants and increased risk for gestational diabetes.
- But experts warn that women who take antidepressants should not stop until they discuss a plan with their doctor.
- The overall increased risk remains relatively low.
Doctors are learning more about how depression and antidepressants can affect the risk of gestational diabetes in pregnant women.
But experts stress this information should be used to help women who are pregnant decide what’s best for their health and not scare them from using needed medications to manage depression.
A study in the journal BMJ Open found that pregnant women taking forms of antidepressants were at 15 to 52 percent higher risk for developing gestational diabetes.
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Taking certain antidepressants while pregnant has been linked to having a higher risk for gestational diabetes. But doctors still warn women not to go off the medication abruptly.
They also stress that the study doesn’t prove antidepressants necessarily cause gestational diabetes.
The link between gestational diabetes and antidepressant use has been studied before. For the current study, the researchers used data from the Quebec Pregnancy Cohort, which includes all pregnancies and children born in Quebec between 1998 and 2015. It included 20,905 cases of gestational diabetes, which were matched with 209,050 unaffected pregnancies.
Of the women, 9,741 women used antidepressants when their pregnancies started and when gestational diabetes was diagnosed.
The women used various antidepressant medications including citalopram, fluoxetine, fluvoxamine, paroxetine, and sertraline, which are common selective serotonin reuptake inhibitor (SSRI) drugs. Additionally some took venlafaxine, which is a serotonin-norepinephrine reuptake inhibitor (SNRI), and some took amitriptyline, a tricyclic antidepressant.
Women taking two or more antidepressants, those on amitriptyline, and those on venlafaxine had an increased risk of developing gestational diabetes.
In the study the overall risk of taking antidepressants was linked to mothers having a 19 percent increased risk for gestational diabetes compared to mothers who didn’t take the medications. But that risk didn’t hold for women who took SSRIs, which wasn’t associated with an increased risk of gestational diabetes.
Women who took the SNRI venlafaxine had a 27 percent higher risk, and women who used amitriptyline had a 52 percent heightened risk. The risk increased the longer the drugs were taken or when they were combined.
Short-term use was associated with a 15 percent heightened risk. Medium-term use was associated with a 17 percent heightened risk. Long-term use with a 29 percent heightened risk. Additionally, the researchers assessed 21,395 women who were formerly diagnosed with depression or anxiety before they became pregnant. Results were similar to the main analysis.
“These increased estimates need to be put into perspective,” said Dr. Anick Bérard, a professor at the University of Montreal who has studied medication use in pregnancy. The baseline prevalence of gestational diabetes is between 7 and 9 percent, so a 15 percent increased risk results in a 10 percent prevalence, while a 52 percent increase is a 14 percent prevalence.
“The increases remain small but above what we would’ve expected,” she said.
The researchers warn that it’s an observational study, so they can’t say that taking antidepressants causes gestational diabetes. But they believe they understand the link.
Antidepressants, which affect serotonin levels, also have an impact on glucose metabolism. Weight gain is a side effect of antidepressants, which also puts people at a risk for diabetes.
“Although biological plausibility is not well understood, we know that antidepressants are associated with weight gain… mostly SSRIs and SNRIs, the most used antidepressants… and that weight gain is associated with insulin resistance and glucose metabolism dysregulation — all risk factors for diabetes,” Dr. Bérard said.
And some data suggests that changes to a receptor targeted by antidepressants can lead to insulin resistance, added Dr. Jodie Katon, a research assistant professor at the University of Washington School of Public Health and Dr. Amritha Bhat, a perinatal psychiatrist at the same institution.
There’s also evidence that depression itself can negatively impact metabolic pathways, they told Healthline.
Women with severe depression who are pregnant or planning to become pregnant need to weigh the pros and cons of taking antidepressants, the researchers warned. Risks from depression can outweigh risks from gestational diabetes, which is why individualized care is best.
“Depression is prevalent before and during pregnancy, and untreated depression can lead to relapse during pregnancy and in the period immediately after birth,” the authors said.
Untreated depression in pregnancy and postpartum can have negative effects on mothers, babies, and families, Katon and Bhat noted.
Women with mild to moderate depression can also use talk therapy (psychotherapy) while not taking antidepressant medication.
“However, there are many pregnant women with severe depression or anxiety, or those who can’t access weekly psychotherapy, and they can’t be left untreated,” Katon and Bhat said in a joint statement.
Bérard said women should plan their pregnancies and talk to their doctors about the risks and benefits of treating depression with antidepressants during pregnancy.
“If a woman is pregnant and is taking an antidepressant, she shouldn’t decide by herself to stop taking it, but should have an informed discussion with her doctor to assess the best way forward,” she said.