PDF herunterladen
Am J Perinatol 2021; 38(13): 1442-1452
DOI: 10.1055/s-0040-1713652
Original Article

Maternal Gestational Weight Gain in Relation to Antidepressant Continuation in Pregnancy

Paige D. Wartko 
1   Department of Epidemiology, University of Washington, Seattle, Washington
2   Kaiser Permanente Washington Health Research Institute, Seattle, Washington
,
Noel S. Weiss
1   Department of Epidemiology, University of Washington, Seattle, Washington
3   Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
,
Daniel A. Enquobahrie
1   Department of Epidemiology, University of Washington, Seattle, Washington
,
Kwun Chuen Gary Chan
4   Department of Biostatistics, University of Washington, Seattle, Washington
,
Alyssa Stephenson-Famy 
5   Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington
,
Beth A. Mueller
1   Department of Epidemiology, University of Washington, Seattle, Washington
3   Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
,
Sascha Dublin
1   Department of Epidemiology, University of Washington, Seattle, Washington
2   Kaiser Permanente Washington Health Research Institute, Seattle, Washington
› Institutsangaben Funding P.D.W. worked on this study while receiving a graduate student stipend from the Stroum Graduate Fellowship through the University of Washington Diabetes Research Center and the National Institute of Child Health and Human Development's Reproductive, Perinatal, and Pediatric Epidemiology Training Grant (T32 HD052462). Funds for data extraction came from a Group Health Foundation Partnership for Innovation grant. Outside the work of this study, P.D.W. receives funding from a research contract awarded to Kaiser Permanente Washington Health Research Institute from a consortium of pharmaceutical companies (Allergan, BioDelivery Sciences, Collegium, Daiichi Sankyo, Depomed, Egalet, Endo, Janssen, Mallinckrodt, Pernix, Pfizer, Purdue, and West-Ward) to conduct Food and Drug Administration-mandated studies on opioids. Also, outside this study, S.D. is a co-investigator for a proposal that was submitted to GlaxoSmithKline by Harvard Department of Population Medicine, which is likely to be funded. S.D. reports grants from Merck and GlaxoSmithKline outside the submitted work.
› Weitere Informationen
    Lizenzen und Reprints

Abstract

Objective Both excessive and inadequate gestational weight gain (GWG) are associated with adverse health outcomes for the woman and her child. Antidepressant use in pregnancy could affect GWG, based on evidence in nonpregnant women that some antidepressants may cause weight gain and others weight loss. Previous studies of antidepressant use and GWG were small with limited ability to account for confounding, including by maternal mental health status and severity. We assessed the association of antidepressant continuation in pregnancy with GWG among women using antidepressants before pregnancy.

Study Design Our retrospective cohort study included singleton livebirths from 2001 to 2014 within Kaiser Permanente Washington, an integrated health care system. Data were obtained from electronic health records and linked Washington State birth records. Among women with ≥1 antidepressant fill within 6 months before pregnancy, women who filled an antidepressant during pregnancy were considered “continuers;” women without a fill were “discontinuers.” We calculated mean differences in GWG and relative risks (RR) of inadequate and excessive weight gain based on Institute of Medicine guidelines. Using inverse probability of treatment weighting with generalized estimating equations, we addressed differences in maternal characteristics, including mental health conditions.

Results Among the 2,887 births, 1,689 (59%) were to women who continued antidepressants in pregnancy and 1,198 (42%) were to discontinuers. After accounting for confounding, continuers had similar weight gain to those who discontinued (mean difference: 1.3 lbs, 95% confidence interval [CI]: −0.1 to 2.8 lbs) and similar risks of inadequate and excessive GWG (RR: 0.95, 95% CI: 0.80–1.14 and RR: 1.06, 95% CI: 0.98–1.14, respectively). Findings were comparable for specific antidepressants and trimesters of exposure.

Conclusion We did not find evidence that continuation of antidepressants in pregnancy led to differences in GWG.

Key Points

  • Antidepressant use is associated with weight change in nonpregnant populations.

  • Prior evidence on whether antidepressant use in pregnancy affects gestational weight gain is sparse.

  • We accounted for confounding by characteristics such as mental health conditions and their severity.

  • We found no association between pregnancy antidepressant continuation and gestational weight gain.

Keywords

antidepressants - pregnancy - gestational weight gain - inadequate gestational weight gain - excessive gestational weight gain - adequacy of gestational weight gain

Supplementary Material



Publikationsverlauf

Eingereicht: 08. November 2019

Angenommen: 19. Mai 2020

Artikel online veröffentlicht:
30. Juni 2020

© 2020. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Huybrechts KF, Palmsten K, Mogun H. et al. National trends in antidepressant medication treatment among publicly insured pregnant women. Gen Hosp Psychiatry 2013; 35 (03) 265-271
    CrossrefPubMedGoogle Scholar
  • 2 Mitchell AA, Gilboa SM, Werler MM. et al. Medication use during pregnancy, with particular focus on prescription drugs: 1976–2008. Am J Obstet Gynecol 2011; 205: 51 e1 8
    CrossrefPubMedGoogle Scholar
  • 3 Hayes RM, Wu P, Shelton RC. et al. Maternal antidepressant use and adverse outcomes: a cohort study of 228,876 pregnancies. Am J Obstet Gynecol 2012; 207: 49e1-9
    CrossrefPubMedGoogle Scholar
  • 4 Serretti A, Mandelli L. Antidepressants and body weight: a comprehensive review and meta-analysis. J Clin Psychiatry 2010; 71 (10) 1259-1272
    CrossrefPubMedGoogle Scholar
  • 5 Papakostas GI. The efficacy, tolerability, and safety of contemporary antidepressants. The Journal of clinical psychiatry. 2010; 71 (Suppl E1): e03
    PubMedGoogle Scholar
  • 6 Arterburn D, Sofer T, Boudreau DM. et al. Long-term weight change after initiating second-generation antidepressants. J Clin Med 2016; 5 (04) 5
    CrossrefPubMedGoogle Scholar
  • 7 Wellman PJ, Davies BT, Morien A, McMahon L. Modulation of feeding by hypothalamic paraventricular nucleus alpha 1- and alpha 2-adrenergic receptors. Life Sci 1993; 53 (09) 669-679
    CrossrefPubMedGoogle Scholar
  • 8 Terry P, Gilbert DB, Cooper SJ. Dopamine receptor subtype agonists and feeding behavior. Obes Res 1995; 3 (Suppl. 04) 515S-523S
    CrossrefPubMedGoogle Scholar
  • 9 Stahl SM, Pradko JF, Haight BR, Modell JG, Rockett CB, Learned-Coughlin S. A review of the neuropharmacology of bupropion, a dual norepinephrine and dopamine reuptake inhibitor. Prim Care Companion J Clin Psychiatry 2004; 6 (04) 159-166
    CrossrefPubMedGoogle Scholar
  • 10 Meister B. Neurotransmitters in key neurons of the hypothalamus that regulate feeding behavior and body weight. Physiol Behav 2007; 92 (1-2): 263-271
    CrossrefPubMedGoogle Scholar
  • 11 Rezvanian H, Hashemipour M, Kelishadi R, Tavakoli N, Poursafa P. A randomized, triple masked, placebo-controlled clinical trial for controlling childhood obesity. World J Pediatr 2010; 6 (04) 317-322
    CrossrefPubMedGoogle Scholar
  • 12 Ye Z, Chen L, Yang Z. et al. Metabolic effects of fluoxetine in adults with type 2 diabetes mellitus: a meta-analysis of randomized placebo-controlled trials. PLoS ONE 2011; 6 (07) e21551
    CrossrefPubMedGoogle Scholar
  • 13 Zimmermann U, Kraus T, Himmerich H, Schuld A, Pollmächer T. Epidemiology, implications and mechanisms underlying drug-induced weight gain in psychiatric patients. J Psychiatr Res 2003; 37 (03) 193-220
    CrossrefPubMedGoogle Scholar
  • 14 Papakostas GI. Tolerability of modern antidepressants. J Clin Psychiatry 2008; 69 (Suppl E1): 8-13
    CrossrefPubMedGoogle Scholar
  • 15 Wisner KL, Sit DK, Hanusa BH. et al. Major depression and antidepressant treatment: impact on pregnancy and neonatal outcomes. Am J Psychiatry 2009; 166 (05) 557-566
    CrossrefPubMedGoogle Scholar
  • 16 Suri R, Altshuler L, Hellemann G, Burt VK, Aquino A, Mintz J. Effects of antenatal depression and antidepressant treatment on gestational age at birth and risk of preterm birth. Am J Psychiatry 2007; 164 (08) 1206-1213
    CrossrefPubMedGoogle Scholar
  • 17 Nulman I, Rovet J, Stewart DE. et al. Child development following exposure to tricyclic antidepressants or fluoxetine throughout fetal life: a prospective, controlled study. Am J Psychiatry 2002; 159 (11) 1889-1895
    CrossrefPubMedGoogle Scholar
  • 18 Nulman I, Koren G, Rovet J. et al. Neurodevelopment of children following prenatal exposure to venlafaxine, selective serotonin reuptake inhibitors, or untreated maternal depression. Am J Psychiatry 2012; 169 (11) 1165-1174
    CrossrefPubMedGoogle Scholar
  • 19 Hartley E, McPhie S, Skouteris H, Fuller-Tyszkiewicz M, Hill B. Psychosocial risk factors for excessive gestational weight gain: a systematic review. Women Birth 2015; 28 (04) e99-e109
    CrossrefPubMedGoogle Scholar
  • 20 Marcus SM. Depression during pregnancy: rates, risks and consequences--Motherisk Update 2008. Can J Clin Pharmacol 2009; 16 (01) e15-e22
    PubMedGoogle Scholar
  • 21 Spaight C, Gross J, Horsch A, Puder JJ. Gestational diabetes mellitus. Endocr Dev 2016; 31: 163-178
    CrossrefPubMedGoogle Scholar
  • 22 Metzger BE. Summary and recommendations of the Third International Workshop-Conference on Gestational Diabetes Mellitus. Diabetes 1991; 40 (Suppl. 02) 197-201
    CrossrefPubMedGoogle Scholar
  • 23 Gilmore LA, Klempel-Donchenko M, Redman LM. Pregnancy as a window to future health: Excessive gestational weight gain and obesity. Semin Perinatol 2015; 39 (04) 296-303
    CrossrefPubMedGoogle Scholar
  • 24 Nehring I, Schmoll S, Beyerlein A, Hauner H, von Kries R. Gestational weight gain and long-term postpartum weight retention: a meta-analysis. Am J Clin Nutr 2011; 94 (05) 1225-1231
    CrossrefPubMedGoogle Scholar
  • 25 Rogozińska E, Zamora J, Marlin N. et al; International Weight Management in Pregnancy (i-WIP) Collaborative Group. Gestational weight gain outside the Institute of Medicine recommendations and adverse pregnancy outcomes: analysis using individual participant data from randomised trials. BMC Pregnancy Childbirth 2019; 19 (01) 322
    CrossrefPubMedGoogle Scholar
  • 26 Baldwin E, Johnson K, Berthoud H, Dublin S. Linking mothers and infants within electronic health records: a comparison of deterministic and probabilistic algorithms. Pharmacoepidemiol Drug Saf 2015; 24 (01) 45-51
    CrossrefPubMedGoogle Scholar
  • 27 Patten SB, Esposito E, Carter B. Reasons for antidepressant prescriptions in Canada. Pharmacoepidemiol Drug Saf 2007; 16 (07) 746-752
    CrossrefPubMedGoogle Scholar
  • 28 Institute of Medicine. Weight gain during pregnancy: reexamining the guidelines. Accessed May, 2009 at: https://www.nap.edu/resource/12584/Report-Brief---Weight-Gain-During-Pregnancy.pdf
    PubMedGoogle Scholar
  • 29 Gilbertson DT, Bradbury BD, Wetmore JB. et al. Controlling confounding of treatment effects in administrative data in the presence of time-varying baseline confounders. Pharmacoepidemiol Drug Saf 2016; 25 (03) 269-277
    CrossrefPubMedGoogle Scholar
  • 30 Manea L, Gilbody S, McMillan D. A diagnostic meta-analysis of the Patient Health Questionnaire-9 (PHQ-9) algorithm scoring method as a screen for depression. Gen Hosp Psychiatry 2015; 37 (01) 67-75
    CrossrefPubMedGoogle Scholar
  • 31 Austin PC. An introduction to propensity score methods for reducing the effects of confounding in observational studies. Multivariate Behav Res 2011; 46 (03) 399-424
    CrossrefPubMedGoogle Scholar
  • 32 Burton P, Gurrin L, Sly P. Extending the simple linear regression model to account for correlated responses: an introduction to generalized estimating equations and multi-level mixed modelling. Stat Med 1998; 17 (11) 1261-1291
    CrossrefPubMedGoogle Scholar
  • 33 Mitchell J, Goodman J. Comparative effects of antidepressant medications and untreated major depression on pregnancy outcomes: a systematic review. Arch Women Ment Health 2018; 21 (05) 505-516
    CrossrefPubMedGoogle Scholar
  • 34 Sujan AC, Rickert ME, Öberg AS. et al. Associations of maternal antidepressant use during the first trimester of pregnancy with preterm birth, small for gestational age, autism spectrum disorder, and attention-deficit/hyperactivity disorder in offspring. JAMA 2017; 317 (15) 1553-1562
    CrossrefPubMedGoogle Scholar
  • 35 Wilcox AJ, Weinberg CR, Basso O. On the pitfalls of adjusting for gestational age at birth. Am J Epidemiol 2011; 174 (09) 1062-1068
    CrossrefPubMedGoogle Scholar
  • 36 Nulman I, Rovet J, Stewart DE. et al. Neurodevelopment of children exposed in utero to antidepressant drugs. N Engl J Med 1997; 336 (04) 258-262
    CrossrefPubMedGoogle Scholar
  • 37 Chambers CD, Johnson KA, Dick LM, Felix RJ, Jones KL. Birth outcomes in pregnant women taking fluoxetine. N Engl J Med 1996; 335 (14) 1010-1015
    CrossrefPubMedGoogle Scholar
  • 38 Pastuszak A, Schick-Boschetto B, Zuber C. et al. Pregnancy outcome following first-trimester exposure to fluoxetine (Prozac). JAMA 1993; 269 (17) 2246-2248
    CrossrefPubMedGoogle Scholar
  • 39 Messerli FH, Bell DS, Fonseca V. et al; GEMINI Investigators. Body weight changes with beta-blocker use: results from GEMINI. Am J Med 2007; 120 (07) 610-615
    CrossrefPubMedGoogle Scholar
  • 40 Domecq JP, Prutsky G, Leppin A. et al. Clinical review: drugs commonly associated with weight change: a systematic review and meta-analysis. J Clin Endocrinol Metab 2015; 100 (02) 363-370
    CrossrefPubMedGoogle Scholar
  • 41 Brookhart MA, Schneeweiss S, Rothman KJ, Glynn RJ, Avorn J, Stürmer T. Variable selection for propensity score models. Am J Epidemiol 2006; 163 (12) 1149-1156
    CrossrefPubMedGoogle Scholar