title: Prenatal Psychostimulant and Antidepressant Exposure and Risk of Hypertensive Disorders of Pregnancy.
abstract: OBJECTIVE
  To investigate the association, if any, of prenatal mental illness and psychotropic exposure with the risk of hypertensive disorders of pregnancy (HDP).
  
  
  METHODS
  A case-cohort analysis was conducted of 686 pregnant women participating in prospective, longitudinal observational studies in a tertiary referral center between January 1998 and May 2012. Risk estimates were produced using multivariate logistic regression modeling. Medication- and diagnosis-specific data were utilized to conduct post hoc confirmatory analyses of the risk estimates.
  
  
  RESULTS
  After adjustment for confounders, HDP were significantly associated with psychostimulant (odds ratio [OR] = 6.11; 95% CI, 1.79-20.9) and serotonin-norepinephrine reuptake inhibitor (SNRI) (OR = 2.57; 95%, 1.34-4.93) exposure following the 20th week of gestation and lifetime histories of cocaine dependence (OR = 2.99; 95% CI, 1.12-7.98) and panic disorder (OR = 1.78; 95% CI, 1.06-2.98) using DSM-IV diagnostic criteria. HDP risk was not associated with prenatal selective serotonin reuptake inhibitor exposure or other psychiatric disorders. Post hoc analyses demonstrated an increased risk for HDP with higher maternal daily doses of amphetamine psychostimulants and the SNRI venlafaxine.
  
  
  CONCLUSIONS
  These data indicate that psychostimulant and SNRI exposure following the 20th week of gestation conveys considerable risk for the emergence of HDP. Overall, the findings suggest that heightened vascular reactivity to noradrenergic, rather than serotonergic, stimulation may be pivotal to HDP risk among women with psychiatric illness.
authors.affiliation: Women's Reproductive Mental Health, University of Miami Miller School of Medicine, 1120 NW 14th St, Ste 1446, Miami, FL 33136. jeff.newport@miami.edu.|Departments of Psychiatry and Behavioral Sciences and Obstetrics and Gynecology, University of Miami Miller School of Medicine, Miami, Florida, USA.
authors.forename: D Jeffrey
authors.initials: DJ
authors.lastname: Newport
authors.affiliation: Private Practice, Atlanta, Georgia, USA.
authors.forename: Amy L
authors.initials: AL
authors.lastname: Hostetter
authors.affiliation: Private Practice, Atlanta, Georgia, USA.
authors.forename: Sarah H
authors.initials: SH
authors.lastname: Juul
authors.affiliation: Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA.
authors.forename: Sunny M
authors.initials: SM
authors.lastname: Porterfield
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
authors.forename: Bettina T
authors.initials: BT
authors.lastname: Knight
authors.affiliation: Department of Pediatrics and Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
authors.forename: Zachary N
authors.initials: ZN
authors.lastname: Stowe
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000008:administration & dosage / Q000009:adverse effects*; D000697:Central Nervous System Stimulants / Q000008:administration & dosage / Q000009:adverse effects*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000139:chemically induced*; D016015:Logistic Models; D001523:Mental Disorders / Q000188:drug therapy*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy*; D011446:Prospective Studies; D012307:Risk Factors; D017367:Selective Serotonin Reuptake Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects*
chemical_list: D000928:Antidepressive Agents; D000697:Central Nervous System Stimulants; D017367:Selective Serotonin Reuptake Inhibitors