Treating depression during pregnancy can be vital to the health of both mother and child, but new research suggests that taking antidepressants may make a woman more vulnerable to gestational diabetes.
Specifically, the drugs venlafaxine (Effexor) and amitriptyline (Endep) were associated with the highest risk, especially when taken for a long time.
Still, "depression needs to be treated during pregnancy," said study author Anick Berard, research chair of medications, pregnancy and lactation at the University of Montreal.
"If a woman is pregnant and is taking antidepressants, she should not stop by herself, but should have a discussion with her physician to assess the best way forward," she said.
There are many types of treatments for depression – antidepressants are only one option, Berard noted.
And because this study looked back at data over time, it can't prove that antidepressants cause gestational diabetes, only that the two appear linked.
But the connection might be that antidepressants affect sugar metabolism. Also, a side effect of antidepressants is weight gain, which is a risk factor for diabetes, Berard and her university colleagues pointed out.
Venlafaxine is in a class of drugs called serotonin and norepinephrine reuptake inhibitors (SNRIs), and amitriptyline is an older type of drug called a tricyclic antidepressant.
Obesity and diabetes later in life
Gestational diabetes can result in overweight babies and longer bouts of labour because the baby can get stuck in the birth canal, the researchers explained.
Also, the infants may be more prone to obesity and diabetes later in life.
For the study, Berard and her team used the Quebec Pregnancy Cohort, which includes all pregnancies and children born in Quebec between 1998 and 2015.
They looked at nearly 21 000 women with gestational diabetes, comparing them with more than 209 000 women without the condition.
Slightly more than 4% of the women with gestational diabetes were taking an antidepressant. These included fluoxetine (Prozac), fluvoxamine (Luvox), paroxetine (Paxil) and sertraline (Zoloft), also known as selective serotonin reuptake inhibitors (SSRIs), along with Effexor or Endep.
Using any of these drugs increased the risk for gestational diabetes by 19%, compared with not taking them.
The riskiest drugs were Effexor, which raised the risk 27%, and Endep, which increased it by 52%, the researchers found. The risk was greater the longer the drugs were taken and if more than one drug was prescribed.
SSRIs carry less risk
Using the drugs for a short time increased the risk 15%, while taking them for a long time raised risk to 29%.
These estimates need to be put in perspective, Berard stressed.
"The baseline prevalence of gestational diabetes is between 7% and 9%, hence a 15% increased risk would result in a prevalence of 10%, whereas a 52% increase would result in a 14% prevalence," she said. "Hence, the increases remain small, but above what we would have expected."
The findings were published in the journal BMJ Open.
Doctors need to be aware that all antidepressants aren't the same when it comes to the risk for gestational diabetes, said Dr Rahul Gupta, chief medical health officer at the March of Dimes.
It appears the SSRIs carry less risk than other antidepressants, Gupta said. But he believes that the first choice to fight depression during pregnancy should be non-pharmaceutical.
This can include counselling, exercise and other ways to cope with depression without drugs.
But women who need these drugs should be taking them, Gupta said. "Depression and the risk of depression may outweigh the risk of gestational diabetes," he said.
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