1
|
Hwang YM, Roper RT, Piekos SN, Enquobahrie DA, Hebert MF, Paquette AG, Baloni P, Price ND, Hood L, Hadlock JJ. Timing of selective serotonin reuptake inhibitor use and risk for preterm birth and related adverse events: with a consideration of the COVID-19 pandemic period. J Matern Fetal Neonatal Med 2024; 37:2313364. [PMID: 38342572 PMCID: PMC11033706 DOI: 10.1080/14767058.2024.2313364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 01/29/2024] [Indexed: 02/13/2024]
Abstract
OBJECTIVE There is uncertainty around the safety of SSRIs for treating depression during pregnancy. Nevertheless, the use of SSRIs has been gradually increasing, especially during the COVID-19 pandemic period. We aimed to (1) characterize maternal depression rate and use of SSRIs in a recent 10-year period, (2) address confounding by indication, as well as socioeconomic and environmental factors, and (3) evaluate associations of the timing of SSRI exposure in pregnancy with risk for preterm birth (PTB), low birthweight (LBW), and small for gestational age (SGA) infants among women with depression before pregnancy. METHODS We conducted propensity score-adjusted regression to calculate odds ratios (ORs) of PTB, LBW, and SGA. We accounted for maternal/pregnancy characteristics, comorbidity, depression severity, time of delivery, social vulnerability, and rural residence. RESULTS There were 50.3% and 40.3% increases in the prevalence rate of prenatal depression and prenatal SSRI prescription rate during the pandemic. We identified women with depression ≤180 days before pregnancy (n = 8406). Women with no SSRI order during pregnancy (n = 3760) constituted the unexposed group. The late SSRI exposure group consisted of women with an SSRI order after the first trimester (n = 3759). The early-only SSRI exposure group consisted of women with SSRI orders only in the first trimester (n = 887). The late SSRI exposure group had an increased risk of PTB of OR = 1.5 ([1.2,1.8]) and LBW of OR = 1.5 ([1.2,2.0]), relative to the unexposed group. Associations between late SSRI exposure and risk of PTB/LBW were similar among a subsample of patients who delivered during the pandemic. CONCLUSIONS These findings suggest an association between PTB/LBW and SSRI exposure is dependent on exposure timing during pregnancy. Small for gestational age is not associated with SSRI exposure.
Collapse
Affiliation(s)
- Yeon Mi Hwang
- Institute for Systems Biology; 401 Terry Ave N, Seattle, Washington, USA 98109
- Molecular Engineering and Sciences Institute, University of Washington; Seattle, Washington, USA
| | - Ryan T. Roper
- Institute for Systems Biology; 401 Terry Ave N, Seattle, Washington, USA 98109
| | - Samantha N. Piekos
- Institute for Systems Biology; 401 Terry Ave N, Seattle, Washington, USA 98109
| | - Daniel A. Enquobahrie
- Department of Epidemiology, School of Public Health, University of Washington; Seattle, Washington, USA
| | - Mary F. Hebert
- Department of Pharmacy, School of Pharmacy, University of Washington; Seattle, Washington, USA
| | - Alison G. Paquette
- Department of Pediatrics, School of Medicine, University of Washington; Seattle, Washington USA
- Center for Developmental Biology and Regenerative Medicine, Seattle Children’s Research Institute; Seattle, Washington USA
| | - Priyanka Baloni
- School of Health Sciences, Purdue University, West Lafayette, Indiana USA
| | - Nathan D. Price
- Institute for Systems Biology; 401 Terry Ave N, Seattle, Washington, USA 98109
- Thorne HealthTech, New York, New York, USA
| | - Leroy Hood
- Institute for Systems Biology; 401 Terry Ave N, Seattle, Washington, USA 98109
- Providence St. Joseph Health; Renton, Washington, USA
| | - Jennifer J. Hadlock
- Institute for Systems Biology; 401 Terry Ave N, Seattle, Washington, USA 98109
| |
Collapse
|
2
|
Domingues RR, Teixeira NN, Frizzarini WS, Beard AD, Connelly MK, Vang A, Wiltbank MC, Hernandez LL. The antidepressant fluoxetine (Prozac®) modulates serotonin signaling to alter maternal peripartum calcium homeostasis. Sci Rep 2023; 13:21832. [PMID: 38071334 PMCID: PMC10710465 DOI: 10.1038/s41598-023-49253-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 12/06/2023] [Indexed: 12/18/2023] Open
Abstract
Antidepressant use is two-fold greater in women compared to men; however, most studies have been performed in male subjects. We aimed to understand the impact of selective serotonin reuptake inhibitors (SSRI, most used antidepressants) on calcium homeostasis and steroid metabolism during the peripartum period. Pregnant sheep (n = 10/group) were treated with vehicle or fluoxetine (most common SSRI) during the last month of gestation. Fluoxetine treatment decreased circulating calcium prior to parturition (8.7 ± 0.1 mg/dL vs 8.2 ± 0.1 mg/dL; P = 0.07). In the control group, total calcium decreased after parturition corresponding to the onset of lactogenesis followed by increase in calcium by day 2 postpartum. Interestingly, this normal transient decrease in circulating calcium was absent in fluoxetine-treated ewes. The steroids cortisol and progesterone were not altered by fluoxetine treatment whereas estradiol was decreased after the onset of treatment (12.4 ± 1.3 vs 9.1 ± 1.2 pg/mL, P = 0.05) and prior to parturition (38.1 ± 8.1 vs 22.3 ± 4.2 pg/mL, P = 0.03). Our hypothesis was supported that fluoxetine treatment alters circulating concentrations of calcium in the peripartum period; however, we surprisingly observed a decrease in estradiol concentrations contrary to reports in in vitro studies.
Collapse
Affiliation(s)
- Rafael R Domingues
- Department of Animal and Dairy Sciences, University of Wisconsin-Madison, 1865 Observatory Dr, Madison, WI, 53706, USA
- Endocrinology and Reproductive Physiology Program, University of Wisconsin-Madison, Madison, WI, USA
- Department of Animal Sciences, The Ohio State University, Columbus, OH, USA
| | - Natalia N Teixeira
- Department of Animal and Dairy Sciences, University of Wisconsin-Madison, 1865 Observatory Dr, Madison, WI, 53706, USA
| | - Waneska S Frizzarini
- Department of Animal and Dairy Sciences, University of Wisconsin-Madison, 1865 Observatory Dr, Madison, WI, 53706, USA
| | - Adam D Beard
- Department of Animal and Dairy Sciences, University of Wisconsin-Madison, 1865 Observatory Dr, Madison, WI, 53706, USA
- Endocrinology and Reproductive Physiology Program, University of Wisconsin-Madison, Madison, WI, USA
| | - Meghan K Connelly
- Department of Animal and Dairy Sciences, University of Wisconsin-Madison, 1865 Observatory Dr, Madison, WI, 53706, USA
| | - Alysia Vang
- Department of Animal and Dairy Sciences, University of Wisconsin-Madison, 1865 Observatory Dr, Madison, WI, 53706, USA
- Endocrinology and Reproductive Physiology Program, University of Wisconsin-Madison, Madison, WI, USA
| | - Milo C Wiltbank
- Department of Animal and Dairy Sciences, University of Wisconsin-Madison, 1865 Observatory Dr, Madison, WI, 53706, USA
- Endocrinology and Reproductive Physiology Program, University of Wisconsin-Madison, Madison, WI, USA
| | - Laura L Hernandez
- Department of Animal and Dairy Sciences, University of Wisconsin-Madison, 1865 Observatory Dr, Madison, WI, 53706, USA.
- Endocrinology and Reproductive Physiology Program, University of Wisconsin-Madison, Madison, WI, USA.
| |
Collapse
|