Antidepressant use during pregnancy and gestational diabetes: a systematic review

Beatriz Tianeze De Castro,Andressa Oliveira Azevedo,Anna Luzia Pinho Quaresma,Romana Santos Gama,Lucas Santana Coelho Da Silva,Caroline Tianeze De Castro,Mariana Souto Figueiredo,Ana Flávia Souto Figueiredo Nepomuceno

doi:10.33448/rsd-v11i2.26278

Abstract

A high number of women are exposed to antidepressants during pregnancy. Considering that an association between exposure to antidepressants and type 2 diabetes was found in the general population and pregnant women are inherently susceptible to insulin resistance, this study aimed to investigate data in the scientific literature on the association between antidepressant use during pregnancy and the risk of developing gestational diabetes mellitus (GDM). This systematic review was conducted according to the PRISMA guidelines. PubMed, Virtual Health Library (VHS), and Web of Science databases were searched to identify observational studies reporting the association between antidepressant use during pregnancy and GDM. Review articles, case reports, case series, clinical trials, and animal studies were excluded. In total, 67 studies were retrieved, of which 3 were included in the systematic review: one case-control and two cohort studies. According to the Newcastle-Ottawa Scale, the three studies were considered high-quality. Through this systematic review, selective serotonin reuptake inhibitors (SSRI) use during pregnancy is not significantly associated with a higher risk of developing GDM. There are still controversies about the association between serotonin and norepinephrine reuptake inhibitors (SNRI) and GDM. The use of tricyclic, tetracyclic, and atypical antidepressants by pregnant women appears to be associated with GDM. Therefore, the available information about the topic is scarce and the condition of further studies is needed.

Highlights

Gestational diabetes mellitus (GDM) is the most common metabolic disturbance during pregnancy (Johns et al., 2018)
2.1 Eligibility criteria and outcome measures Original articles reporting observational studies that investigated the association between antidepressant use at any time in pregnancy and the development of gestational diabetes mellitus were eligible for inclusion
GDM was considered as the main outcome of interest for this systematic review, defined as a glucose intolerance resulting in hyperglycemia manifested and diagnosed for the first-time during pregnancy (American Diabetes Association, 2020) or according to the criteria adopted by each study

Summary

Introduction

Gestational diabetes mellitus (GDM) is the most common metabolic disturbance during pregnancy (Johns et al., 2018). It is defined as a glucose intolerance resulting in hyperglycemia manifested and diagnosed for the first time during the second or third trimester of pregnancy that was not overt diabetes before gestation (American Diabetes Association, 2020). Women with GDM are at higher risk of birth complications as cesarean delivery, pre-eclampsia, preterm birth, and macrosomia, and are more likely to develop type 2 diabetes (Johns et al, 2018; Szmuilowicz et al, 2019). Children born to women with GDM are more predisposed to type 2 diabetes, obesity, and some neurodevelopment disorders as autism spectrum disorders, intellectual disability, and attention-deficit/hyperactivity disorder (ADHD) (Chen et al, 2021; Szmuilowicz et al, 2019)

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