Antidepressants may increase risk of gestational diabetes

Using antidepressants during pregnancy may increase the risk of developing gestational diabetes, according to a new study published on October 1 in BMJ Open. The nested case-control study is the first to investigate the effects of different antidepressant classes and duration of use on the risk of gestational diabetes.

“Adverse outcomes associated with [antidepressant] use during pregnancy, including [gestational diabetes], should be weighed against the consequences of nonmedicated depression, especially for women with severe depression,” the study authors wrote.

Using the Quebec Pregnancy Cohort, a Canadian provincial database on pregnancies in Quebec from January 1998 to December 2015, Dandjinou and colleagues matched 20,905 cases of gestational diabetes to 209,050 controls without the disease. The researchers assessed only singleton pregnancies, excluding individuals who were overweight or had obesity, type 1 or 2 diabetes, prior gestational diabetes, or cystic fibrosis.

Of those who developed gestational diabetes, 1,152 (5.5%) were exposed to antidepressants. This translated to a 19% greater risk of the disease among those who used antidepressants during pregnancy compared with those who didn’t.

SNRIs and tricyclic antidepressants (TCAs), in particular, were linked to a 27% and 47% higher risk of developing gestational diabetes, respectively. Using a combination of two or more classes of antidepressants was associated with a 38% higher risk. Specifically, venlafaxine, an SNRI, increased the risk of gestational diabetes by 27%, while amitriptyline, a TCA, increased it by 52%. Of note, SSRIs, including citalopram, paroxetine, and sertraline, did not pose a higher risk of developing the disease.

Duration of antidepressant use also appeared to contribute to the risk of developing gestational diabetes. Using the medication for a short duration (90 days or less) increased disease risk by 15%, medium duration (between 90 to 180 days) by 17%, and long duration (180 days or more) by 29%.

The researchers noted that the link between antidepressant use and gestational diabetes may be explained by the medications’ effects on glucose homeostasis. Antidepressants can also decrease pancreatic insulin secretion, increase cellular insulin resistance, or cause weight gain.

In light of these results, pharmacists and other providers should consider the risks of antidepressant use during pregnancy and discuss them with patients, especially those with severe depression, currently using antidepressants, or at risk of developing gestational diabetes.