title: Treatment with serotonin reuptake inhibitors during pregnancy is associated with elevated corticotropin-releasing hormone levels.
abstract: Treatment with serotonin reuptake inhibitors (SSRI) has been associated with an increased risk of preterm birth, but causality remains unclear. While placental CRH production is correlated with gestational length and preterm birth, it has been difficult to establish if psychological stress or mental health problems are associated with increased CRH levels. This study compared second trimester CRH serum concentrations in pregnant women on SSRI treatment (n=207) with untreated depressed women (n=56) and controls (n=609). A secondary aim was to investigate the combined effect of SSRI treatment and CRH levels on gestational length and risk for preterm birth. Women on SSRI treatment had significantly higher second trimester CRH levels than controls, and untreated depressed women. CRH levels and SSRI treatment were independently associated with shorter gestational length. The combined effect of SSRI treatment and high CRH levels yielded the highest risk estimate for preterm birth. SSRI treatment during pregnancy is associated with increased CRH levels. However, the elevated risk for preterm birth in SSRI users appear not to be mediated by increased placental CRH production, instead CRH appear as an independent risk factor for shorter gestational length and preterm birth.
authors.affiliation: Department of Women's and Children's Health, Uppsala University, Uppsala, SE-751 85, Sweden. Electronic address: annakarin.hannerfors@kbh.uu.se.
authors.forename: A-K
authors.initials: AK
authors.lastname: Hannerfors
authors.affiliation: Department of Women's and Children's Health, Uppsala University, Uppsala, SE-751 85, Sweden.
authors.forename: C
authors.initials: C
authors.lastname: Hellgren
authors.affiliation: Department of Women's and Children's Health, Uppsala University, Uppsala, SE-751 85, Sweden.
authors.forename: D
authors.initials: D
authors.lastname: Schijven
authors.affiliation: Department of Women's and Children's Health, Uppsala University, Uppsala, SE-751 85, Sweden.
authors.forename: S I
authors.initials: SI
authors.lastname: Iliadis
authors.affiliation: Department of Women's and Children's Health, Uppsala University, Uppsala, SE-751 85, Sweden; Department of Neuroscience, Uppsala University, Uppsala, Sweden.
authors.forename: E
authors.initials: E
authors.lastname: Comasco
authors.affiliation: Department of Women's and Children's Health, Uppsala University, Uppsala, SE-751 85, Sweden.
authors.forename: A
authors.initials: A
authors.lastname: Skalkidou
authors.affiliation: Department of Women's and Children's Health, Uppsala University, Uppsala, SE-751 85, Sweden; Department of Behavioral Physiology, University of Groningen, The Netherlands.
authors.forename: J D A
authors.initials: JD
authors.lastname: Olivier
authors.affiliation: Department of Women's and Children's Health, Uppsala University, Uppsala, SE-751 85, Sweden. Electronic address: Inger.Sundstrom@kbh.uu.se.
authors.forename: I
authors.initials: I
authors.lastname: Sundström-Poromaa
mesh_terms: D000328:Adult; D003346:Corticotropin-Releasing Hormone / Q000097:blood*; D003866:Depressive Disorder / Q000097:blood / Q000188:drug therapy*; D005260:Female; D006801:Humans; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D011263:Pregnancy Trimester, Third; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D013315:Stress, Psychological / Q000097:blood*; D055815:Young Adult
chemical_list: D003346:Corticotropin-Releasing Hormone; D017367:Selective Serotonin Reuptake Inhibitors
keywords: Corticotropin releasing hormone; Depression; Gestational length; Pregnancy; Preterm birth; Serotonin reuptake inhibitor