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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
› Author Affiliations
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.
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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



Publication History

Received: 08 November 2019

Accepted: 19 May 2020

Article published online:
30 June 2020

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