Pregnancy outcomes following maternal venlafaxine use: A prospective observational comparative cohort study

Richardson, Jonathan L.; Martin, Florence; Dunstan, Hannah J.; Greenall, Amanda J.; Stephens, Sally; Yates, Laura; Thomas, Simon H.L.

doi:10.1016/j.reprotox.2019.01.003

Cited by 22 publications

(30 citation statements)

References 20 publications

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“…All prospective cohort studies assessing antidepressant exposure during pregnancy were included. Eight studies (Calderon-Margalit et al, 2009;Lund et al, 2009;El Marroun et al, 2012;Nordeng et al, 2012;Viktorin et al, 2016;Laine et al, 2019;Richardson et al, 2019) were conducted in Europe, 13 (Källeń, 2004;Sivojelezova et al, 2005;Djulus et al, 2006;Suri et al, 2007;Wisner et al, 2009;Einarson et al, 2010;Einarson et al, 2011;Latendresse and Ruiz, 2011;Yonkers et al, 2012;Klieger-Grossmann et al, 2012;Sadowski et al, 2013;Winterfeld et al, 2015;Yonkers et al, 2017) in North America, 1 in Asia and southeast Europe (Sahingöz et al, 2014), and 1 in Australia (Lewis et al, 2010). The included studies all defined PTB as gestational weeks <37, with the exception of one study, (Malm et al, 2015, which classified PTB into two types [late preterm (32−36 gestational weeks) and very preterm (< 32 weeks) births].…”

Section: Search Resultsmentioning

confidence: 99%

“…Most studies evaluated the association between SSRI use and the risk of PTB (n = 12) (Källeń, 2004;Sivojelezova et al, 2005;Suri et al, 2007;Wisner et al, 2009;McDonald et al, 2010;El Marroun et al, 2012;Yonkers et al, 2012;Huybrechts et al, 2014;Sahingöz et al, 2014;Malm et al, 2015;Viktorin et al, 2016;Yonkers et al, 2017); four studies evaluated the association between the use of all antidepressants and PTB (Suri et al, 2007;Einarson et al, 2010;Nordeng et al, 2012;Laine et al, 2019); four studies evaluated the association between tricyclic antidepressant (TCA) (Källeń, 2004), mirtazapine (Djulus et al, 2006;Winterfeld et al, 2015), and venlafaxine (Richardson et al, 2019) use and PTB; three studies evaluated the association between the use of one or more antidepressants (Calderon-Margalit et al, 2009;Lewis et al, 2010;Einarson et al, 2011) and PTB; and one study evaluated the association between second-generation antipsychotics (SGAs) (Sadowski et al, 2013) (e.g., SSRIs, benzodiazepines, anticonvulsants, SNRIs, atypical antidepressants) and PTB. Eight studies recruited patients through the Teratology Information Service (Sivojelezova et al, 2005;Djulus et al, 2006;Einarson et al, 2010;Einarson et al, 2011;Klieger-Grossmann et al, 2012;Sadowski et al, 2013;Winterfeld et al, 2015;Richardson et al, 2019) and four studies recruited participants from the national birth registry (Källeń, 2004;Viktorin et...…”

Section: Search Resultsmentioning

confidence: 99%

“…Sixteen studies (Källeń, 2004;Sivojelezova et al, 2005;Lund et al, 2009;Calderon-Margalit et al, 2009;Wisner et al, 2009;Einarson et al, 2010;Einarson et al, 2011;Latendresse and Ruiz, 2011;Nordeng et al, 2012;Klieger-Grossmann et al, 2012;Sadowski et al, 2013;Winterfeld et al, 2015;Malm et al, 2015;Yonkers et al, 2017;Richardson et al, 2019;Laine et al, 2019) in the general pregnant female population were included for this analysis. The adjusted RR was 1.35 (95% CI 1.11−1.63, I 2 = 75.8%, P < 0.001, Figure 2).…”

Section: Antidepressant Use In the General Pregnant Female Populationmentioning

confidence: 99%

See 2 more Smart Citations

Antidepressant Use in Depressed Women During Pregnancy and the Risk of Preterm Birth: A Systematic Review and Meta-Analysis of 23 Cohort Studies

Chang

et al. 2020

Front. Pharmacol.

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Objective: The associations between maternal use of antidepressant during pregnancy and preterm birth (PTB) has been the subject of much discussion and controversy. The aim of the present study was to systematically review the association between antidepressant use during pregnancy and the risk of PTB, especially in depressed women.Methods: A computerized search was conducted in PubMed, PsycINFO, and Embase before June 30, 2019, supplemented with a manual search of the reference lists, to identify original research regarding PTB rates in women taking antidepressants during pregnancy. A random-effects model was used to calculate the summarized relative risks (RRs) and 95% confidence intervals (CIs). The potential for publication bias was examined through Begg' s and Egger' s tests.Results: A total of 2,279 articles were reviewed, 23 of which were selected. The risk of PTB was increased in women with depression [1.58 (1.23−2.04)] and in the general pregnant female population [1.35 (1.11−1.63)] who used antidepressants during pregnancy. Similar results were observed in depressed women treated with selective serotonin reuptake inhibitors (SSRIs) during pregnancy [1.46 (1.32−1.61)]. There was no significantly increased risk of PTB observed with SSRI use in the general pregnant female population [1.25 (1.00−1.57)], and the heterogeneity of these studies was high. Conclusions:The results of this meta-analysis indicate maternal antidepressant use is associated with a significantly increased risk of PTB in infants. Health care providers and pregnant women must weigh the risk-benefit potential of these drugs when making decisions about whether to treat with antidepressant during pregnancy.

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Section: Search Resultsmentioning

confidence: 99%

Section: Search Resultsmentioning

confidence: 99%

Section: Antidepressant Use In the General Pregnant Female Populationmentioning

confidence: 99%

See 1 more Smart Citation

Antidepressant Use in Depressed Women During Pregnancy and the Risk of Preterm Birth: A Systematic Review and Meta-Analysis of 23 Cohort Studies

Chang

et al. 2020

Front. Pharmacol.

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“…However, women who stopped taking SRI before becoming pregnant also had a high rate of early miscarriages. In a recent study Richardson et al [52] compared the rate of spontaneous abortion in women treated during early pregnancy with venlafaxine—an SNRI—with SRI and unexposed women and found, after correction for the gestational age at reporting, no differences in the rate of miscarriage between the three groups.…”

Section: Complications Of Pregnancymentioning

confidence: 99%

“…Oberlander et al [18] found that the rate of prematurity was doubled among women taking SRI compared to women with or without a history of psychiatric morbidity. Some studies reported that the risk of prematurity was not increased among SRI users, while the risk of SGA offspring did increase [15,52]. Ramos et al (55] and Kalderon et al [56] found an increased risk for prematurity only after taking SRI in the second or third trimesters of pregnancy [55,56].…”

Section: Complications Of Pregnancymentioning

confidence: 99%

SSRIs and SNRIs (SRI) in Pregnancy: Effects on the Course of Pregnancy and the Offspring: How Far Are We from Having All the Answers?

Ornoy¹,

Koren

2019

IJMS

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Serotonin has important roles in the development of the brain and other organs. Manipulations of synaptic serotonin by drugs such as serotonin reuptake inhibitors (SRI) or serotonin norepinephrine reuptake inhibitors (SNRI) might alter their development and function. Of interest, most studies on the outcome of prenatal exposure to SRI in human have not found significant embryonic or fetal damage, except for a possible, slight increase in cardiac malformations. In up to a third of newborns exposed to SRI, exposure may induce transient neonatal behavioral changes (poor neonatal adaptation) and increased rate of persistent pulmonary hypertension. Prenatal SRI may also cause slight motor delay and language impairment but these are transient. The data on the possible association of prenatal SRIs with autism spectrum disorder (ASD) are inconsistent, and seem to be related to pre-pregnancy treatment or to maternal depression. Prenatal SRIs also appear to affect the hypothalamic hypophyseal adrenal (HPA) axis inducing epigenetic changes, but the long-term consequences of these effects on humans are as yet unknown. SRIs are metabolized in the liver by several cytochrome P450 (CYP) enzymes. Faster metabolism of most SRIs in late pregnancy leads to lower maternal concentrations, and thus potentially to decreased efficacy which is more prominent in women that are rapid metabolizers. Studies suggest that the serotonin transporter SLC6A4 promoter is associated with adverse neonatal outcomes after SRI exposure. Since maternal depression may adversely affect the child’s development, one has to consider the risk of SRI discontinuation on the fetus and the child. As with any drug treatment in pregnancy, the benefits to the mother should be considered versus the possible hazards to the developing embryo/fetus.

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Maternal Use of Specific Antidepressant Medications During Early Pregnancy and the Risk of Selected Birth Defects

et al. 2020

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IMPORTANCE Antidepressants are commonly used during pregnancy, but limited information is available about individual antidepressants and specific birth defect risks.OBJECTIVE To examine associations between individual antidepressants and specific birth defects with and without attempts to partially account for potential confounding by underlying conditions. DESIGN, SETTING, AND PARTICIPANTSThe population-based, multicenter case-control National Birth Defects Prevention Study (October 1997-December 2011) included cases with selected birth defects who were identified from surveillance systems; controls were randomly sampled live-born infants without major birth defects. Mothers of cases and controls participated in an interview after the expected delivery date. The data were analyzed after the completion of the National Birth Defects Prevent Study's data collection.EXPOSURES Self-reported antidepressant exposure was coded to indicate monotherapy exposure to antidepressants. MAIN OUTCOMES AND MEASURESWe used multivariable logistic regression to calculate adjusted odds ratios (aORs) and 95% confidence intervals for associations between maternal antidepressant use and birth defects. We compared early pregnancy antidepressant-exposed women with those without antidepressant exposure and, to partially account for confounding by underlying maternal conditions, those exposed to antidepressants outside of the birth defect development critical period. RESULTSThis study included 30 630 case mothers of infants with birth defects and 11 478 control mothers (aged 12-53 years). Early pregnancy antidepressant use was reported by 1562 case mothers (5.1%) and 467 control mothers (4.1%), for whom elevated aORs were observed for individual selective serotonin reuptake inhibitors (SSRIs) and selected congenital heart defects (CHD) (eg, fluoxetine and anomalous pulmonary venous return: aOR, 2.56; 95% CI, 1.10-5.93; this association was attenuated after partially accounting for underlying conditions: aOR, 1.89; 95% CI, 0.56-6.42). This pattern was observed for many SSRI-CHD combinations. Associations between SSRIs and non-CHD birth defects often persisted or strengthened after partially accounting for underlying conditions (eg, citalopram and diaphragmatic hernia: aOR, 5.11; 95% CI, 1.29-20.24). Venlafaxine had elevated associations with multiple defects that persisted after partially accounting for underlying conditions (eg, anencephaly and craniorachischisis: aOR, 9.14; 95% CI, 1.91-43.83). CONCLUSIONS AND RELEVANCEWe found some associations between maternal antidepressant use and specific birth defects. Venlafaxine was associated with the highest number of defects, which needs confirmation given the limited literature on venlafaxine use during pregnancy and risk for birth defects. Our results suggest confounding by underlying conditions should be considered when assessing risk. Fully informed treatment decision-making requires balancing the risks and benefits of proposed interventions against those of untreated depression or anxiety.

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Pregnancy outcomes following maternal venlafaxine use: A prospective observational comparative cohort study

Cited by 22 publications

References 20 publications

Antidepressant Use in Depressed Women During Pregnancy and the Risk of Preterm Birth: A Systematic Review and Meta-Analysis of 23 Cohort Studies

Antidepressant Use in Depressed Women During Pregnancy and the Risk of Preterm Birth: A Systematic Review and Meta-Analysis of 23 Cohort Studies

SSRIs and SNRIs (SRI) in Pregnancy: Effects on the Course of Pregnancy and the Offspring: How Far Are We from Having All the Answers?

Maternal Use of Specific Antidepressant Medications During Early Pregnancy and the Risk of Selected Birth Defects

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