Antidepressant use during pregnancy and risk of obstetrics and neonatal outcomes: A propensity score-weighted population-based cohort study in 2003–2018

Abstract

Gestational antidepressant exposure may be associated with increased risks of adverse obstetric and neonatal complications, but many earlier studies inadequately addressed confounders and were conducted in Western countries. This population-based cohort study identified women aged 15–50 years who delivered first/singleton child in 2003–2018, using data from electronic health-record database of public healthcare services, with an aim to examine the risks of a comprehensive range of adverse obstetric and neonatal outcomes associated with gestational antidepressant use in a predominantly Chinese population in Hong Kong. Propensity-score fine-stratification weighted logistic-regression analyses were performed to assess the risks following gestational exposure to any antidepressant, specific drug classes and individual antidepressants. Sensitivity analyses addressing exposure-misclassification, confounding by underlying condition and treatment indication were conducted. Our results showed that, of 466,139 women, 2699 redeemed ≥1 antidepressant prescription during pregnancy. Any antidepressant exposure was associated with increased risk of somatic admission ≤90 days after index-delivery discharge (adjusted odds-ratio: 1.29 [95 % CI: 1.11–1.50]), low 1-minute Apgar score (1.31[1.08–1.60]), and special-care-baby-unit (SCBU) admission (1.41[1.30–1.54]). Selective-serotonin-reuptake-inhibitors (SSRIs) and tricyclic-antidepressants were associated with elevated risk of post-delivery somatic admission and SCBU admission. SSRIs were associated with low 1-minute Apgar score, serotonin-and-norepinephrine-inhibitors were related to SCBU admission. Significant associations were not consistently affirmed across sensitivity analyses. Most individual antidepressants were not associated with most adverse outcomes, albeit limited by a reduced sample size. In conclusion, antidepressants are generally not associated with most adverse obstetric and neonatal outcomes except transient neonatal symptoms. Further research clarifying comparative reproductive safety of individual antidepressants is required.