title: Antidepressant use and risk for preeclampsia.
abstract: BACKGROUND
  Prior studies suggest that women who use antidepressants during pregnancy have an increased risk for preeclampsia, yet the comparative safety of specific antidepressants remains unclear. US nationwide Medicaid Analytic eXtract (MAX) data have not been used to study medication safety during pregnancy.
  
  
  METHODS
  We identified 100,942 pregnant women with depression from 2000 to 2007 MAX data. We used pharmacy dispensing records to ascertain exposure to selective serotonin reuptake inhibitor (SSRI), serotonin-norepenephrine reuptake inhibitor (SNRI), tricyclic, bupropion, other antidepressant monotherapy or polytherapy, and specific antidepressants, during the second trimester and first half of the third trimester. Relative risks (RRs) and 95% confidence intervals (CIs) were adjusted for delivery year, preeclampsia risk factors, depression severity proxies, other antidepressant indications, other medications, and healthcare utilization.
  
  
  RESULTS
  The risk of preeclampsia was 5.4% among women with depression and no antidepressant exposure. Compared with these women, the risk for preeclampsia was higher among those receiving SNRI (RR: 1.52, 95% CI = 1.26-1.83) and tricyclic monotherapy (RR: 1.62, 95% CI = 1.23-2.12), but not SSRI monotherapy (RR: 1.00, 95% CI = 0.93-1.07) or other antidepressants. Compared with women receiving SSRI monotherapy, preeclampsia risk was higher among women with SNRI (RR: 1.54, 95% CI = 1.28-1.86) and tricyclic (RR: 1.64, 95% CI = 1.25-2.16) monotherapy. None of the specific SSRIs was associated with preeclampsia. The RR with venlafaxine was 1.57 (95% CI = 1.29-1.91) and with amitriptyline 1.72 (95% CI = 1.24-2.40).
  
  
  CONCLUSIONS
  In this population, SNRIs and tricyclics were associated with a higher risk of preeclampsia than SSRIs.
authors.affiliation: Department of Epidemiology, Harvard School of Public Health, Boston, MA 02115, USA. kkp762@mail.harvard.edu
authors.forename: Kristin
authors.initials: K
authors.lastname: Palmsten
authors.forename: Krista F
authors.initials: KF
authors.lastname: Huybrechts
authors.forename: Karin B
authors.initials: KB
authors.lastname: Michels
authors.forename: Paige L
authors.initials: PL
authors.lastname: Williams
authors.forename: Helen
authors.initials: H
authors.lastname: Mogun
authors.forename: Soko
authors.initials: S
authors.lastname: Setoguchi
authors.forename: Sonia
authors.initials: S
authors.lastname: Hernández-Díaz
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000009:adverse effects*; D000929:Antidepressive Agents, Tricyclic / Q000009:adverse effects; D016208:Databases, Factual; D003863:Depression / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008484:Medicaid; D011225:Pre-Eclampsia / Q000139:chemically induced*; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D011263:Pregnancy Trimester, Third; D018570:Risk Assessment; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects; D014481:United States
chemical_list: D000928:Antidepressive Agents; D000929:Antidepressive Agents, Tricyclic; D017367:Selective Serotonin Reuptake Inhibitors