Associations between Maternal Depression, Antidepressant Use during Pregnancy, and Adverse Pregnancy Outcomes: An Individual Participant Data Meta-analysis

Richelle Vlenterie; Marleen M.H.J. Van Gelder; H. Ross Anderson; Liselott Andersson; Birit F.P. Broekman; Gal Dubnov-Raz; Hanan El Marroun; Ema Ferreira; Emma Fransson; Frank M.M.A. Van Der Heijden; Claudia B. Holzman; J. Jo Kim; Ali S. Khashan; Betty R. Kirkwood; Harold J.H. Kuijpers; Marius Lahti-Pulkkinen; Dan Mason; Dawn Misra; Maria Niemi; Hedvig M.E. Nordeng; Janet L. Peacock; Kate E. Pickett; Stephanie L. Prady; Shahirose S. Premji; Katri Räikkönen; Christine Rubertsson; Mine Sahingoz; Kiran Shaikh; Richard K. Silver; Jaime Slaughter-Acey; Seyi Soremekun; Dan J. Stein; Inger Sundström-Poromaa; Anne Laure Sutter-Dallay; Henning Tiemeier; Faruk Uguz; Pinelopi Varela; Tanja G.M. Vrijkotte; Ursula Winterfeld; Heather J. Zar; Iannis M. Zervas; Judith B. Prins; Monica Pop-Purceleanu; Nel Roeleveld

doi:10.1097/AOG.0000000000004538

Associations between Maternal Depression, Antidepressant Use during Pregnancy, and Adverse Pregnancy Outcomes: An Individual Participant Data Meta-analysis

Richelle Vlenterie, Marleen M.H.J. Van Gelder^*, H. Ross Anderson, Liselott Andersson, Birit F.P. Broekman, Gal Dubnov-Raz, Hanan El Marroun, Ema Ferreira, Emma Fransson, Frank M.M.A. Van Der Heijden, Claudia B. Holzman, J. Jo Kim, Ali S. Khashan, Betty R. Kirkwood, Harold J.H. Kuijpers, Marius Lahti-Pulkkinen, Dan Mason, Dawn Misra, Maria Niemi, Hedvig M.E. NordengJanet L. Peacock, Kate E. Pickett, Stephanie L. Prady, Shahirose S. Premji, Katri Räikkönen, Christine Rubertsson, Mine Sahingoz, Kiran Shaikh, Richard K. Silver, Jaime Slaughter-Acey, Seyi Soremekun, Dan J. Stein, Inger Sundström-Poromaa, Anne Laure Sutter-Dallay, Henning Tiemeier, Faruk Uguz, Pinelopi Varela, Tanja G.M. Vrijkotte, Ursula Winterfeld, Heather J. Zar, Iannis M. Zervas, Judith B. Prins, Monica Pop-Purceleanu, Nel Roeleveld

^*Corresponding author for this work

Pediatrics

Research output: Contribution to journal › Review article › peer-review

34 Scopus citations

Abstract

OBJECTIVE:To evaluate the associations of depressive symptoms and antidepressant use during pregnancy with the risks of preterm birth, low birth weight, small for gestational age (SGA), and low Apgar scores.DATA SOURCES:MEDLINE, EMBASE, ClinicalTrials.gov, and PsycINFO up to June 2016.METHODS OF STUDY SELECTION:Data were sought from studies examining associations of depression, depressive symptoms, or use of antidepressants during pregnancy with gestational age, birth weight, SGA, or Apgar scores. Authors shared the raw data of their studies for incorporation into this individual participant data meta-analysis.TABULATION, INTEGRATION, AND RESULTS:We performed one-stage random-effects meta-analyses to estimate odds ratios (ORs) with 95% CIs. The 215 eligible articles resulted in 402,375 women derived from 27 study databases. Increased risks were observed for preterm birth among women with a clinical diagnosis of depression during pregnancy irrespective of antidepressant use (OR 1.6, 95% CI 1.2-2.1) and among women with depression who did not use antidepressants (OR 2.2, 95% CI 1.7-3.0), as well as for low Apgar scores in the former (OR 1.5, 95% CI 1.3-1.7), but not the latter group. Selective serotonin reuptake inhibitor (SSRI) use was associated with preterm birth among women who used antidepressants with or without restriction to women with depressive symptoms or a diagnosis of depression (OR 1.6, 95% CI 1.0-2.5 and OR 1.9, 95% CI 1.2-2.8, respectively), as well as with low Apgar scores among women in the latter group (OR 1.7, 95% CI 1.1-2.8).CONCLUSION:Depressive symptoms or a clinical diagnosis of depression during pregnancy are associated with preterm birth and low Apgar scores, even without exposure to antidepressants. However, SSRIs may be independently associated with preterm birth and low Apgar scores.SYSTEMATIC REVIEW REGISTRATION:PROSPERO, CRD42016035711.

Original language	English
Pages (from-to)	633-646
Number of pages	14
Journal	Obstetrics and Gynecology
Volume	138
Issue number	4
DOIs	https://doi.org/10.1097/AOG.0000000000004538
State	Published - 1 Oct 2021

Funding

Funders	Funder number
Aga Khan University School of Nursing Student Fund
Dutch Medical Research Council
Erasmus University
National Institutes of Health
National Institute of Mental Health
Patient-Centered Outcomes Research Institute
Cilag
Stichting Volksbond Rotterdam
Alberta Centre for Child, Family and Community Research
National Institute for Health and Care Research
European Commission
ZonMw	836011020
Academy of Finland
Nederlandse Organisatie voor Wetenschappelijk Onderzoek	016 VICI.170.200

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10.1097/AOG.0000000000004538

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Vlenterie, R., Van Gelder, M. M. H. J., Anderson, H. R., Andersson, L., Broekman, B. F. P., Dubnov-Raz, G., El Marroun, H., Ferreira, E., Fransson, E., Van Der Heijden, F. M. M. A., Holzman, C. B., Kim, J. J., Khashan, A. S., Kirkwood, B. R., Kuijpers, H. J. H., Lahti-Pulkkinen, M., Mason, D., Misra, D., Niemi, M., ... Roeleveld, N. (2021). Associations between Maternal Depression, Antidepressant Use during Pregnancy, and Adverse Pregnancy Outcomes: An Individual Participant Data Meta-analysis. Obstetrics and Gynecology, 138(4), 633-646. https://doi.org/10.1097/AOG.0000000000004538

@article{94407d1bf3cb4113b59b0a1ed6a8f79c,

title = "Associations between Maternal Depression, Antidepressant Use during Pregnancy, and Adverse Pregnancy Outcomes: An Individual Participant Data Meta-analysis",

abstract = "OBJECTIVE:To evaluate the associations of depressive symptoms and antidepressant use during pregnancy with the risks of preterm birth, low birth weight, small for gestational age (SGA), and low Apgar scores.DATA SOURCES:MEDLINE, EMBASE, ClinicalTrials.gov, and PsycINFO up to June 2016.METHODS OF STUDY SELECTION:Data were sought from studies examining associations of depression, depressive symptoms, or use of antidepressants during pregnancy with gestational age, birth weight, SGA, or Apgar scores. Authors shared the raw data of their studies for incorporation into this individual participant data meta-analysis.TABULATION, INTEGRATION, AND RESULTS:We performed one-stage random-effects meta-analyses to estimate odds ratios (ORs) with 95% CIs. The 215 eligible articles resulted in 402,375 women derived from 27 study databases. Increased risks were observed for preterm birth among women with a clinical diagnosis of depression during pregnancy irrespective of antidepressant use (OR 1.6, 95% CI 1.2-2.1) and among women with depression who did not use antidepressants (OR 2.2, 95% CI 1.7-3.0), as well as for low Apgar scores in the former (OR 1.5, 95% CI 1.3-1.7), but not the latter group. Selective serotonin reuptake inhibitor (SSRI) use was associated with preterm birth among women who used antidepressants with or without restriction to women with depressive symptoms or a diagnosis of depression (OR 1.6, 95% CI 1.0-2.5 and OR 1.9, 95% CI 1.2-2.8, respectively), as well as with low Apgar scores among women in the latter group (OR 1.7, 95% CI 1.1-2.8).CONCLUSION:Depressive symptoms or a clinical diagnosis of depression during pregnancy are associated with preterm birth and low Apgar scores, even without exposure to antidepressants. However, SSRIs may be independently associated with preterm birth and low Apgar scores.SYSTEMATIC REVIEW REGISTRATION:PROSPERO, CRD42016035711.",

author = "Richelle Vlenterie and {Van Gelder}, {Marleen M.H.J.} and Anderson, {H. Ross} and Liselott Andersson and Broekman, {Birit F.P.} and Gal Dubnov-Raz and {El Marroun}, Hanan and Ema Ferreira and Emma Fransson and {Van Der Heijden}, {Frank M.M.A.} and Holzman, {Claudia B.} and Kim, {J. Jo} and Khashan, {Ali S.} and Kirkwood, {Betty R.} and Kuijpers, {Harold J.H.} and Marius Lahti-Pulkkinen and Dan Mason and Dawn Misra and Maria Niemi and Nordeng, {Hedvig M.E.} and Peacock, {Janet L.} and Pickett, {Kate E.} and Prady, {Stephanie L.} and Premji, {Shahirose S.} and Katri R{\"a}ikk{\"o}nen and Christine Rubertsson and Mine Sahingoz and Kiran Shaikh and Silver, {Richard K.} and Jaime Slaughter-Acey and Seyi Soremekun and Stein, {Dan J.} and Inger Sundstr{\"o}m-Poromaa and Sutter-Dallay, {Anne Laure} and Henning Tiemeier and Faruk Uguz and Pinelopi Varela and Vrijkotte, {Tanja G.M.} and Ursula Winterfeld and Zar, {Heather J.} and Zervas, {Iannis M.} and Prins, {Judith B.} and Monica Pop-Purceleanu and Nel Roeleveld",

year = "2021",

month = oct,

day = "1",

doi = "10.1097/AOG.0000000000004538",

language = "אנגלית",

volume = "138",

pages = "633--646",

journal = "Obstetrics and Gynecology",

issn = "0029-7844",

publisher = "Lippincott Williams and Wilkins",

number = "4",

}

Vlenterie, R, Van Gelder, MMHJ, Anderson, HR, Andersson, L, Broekman, BFP, Dubnov-Raz, G, El Marroun, H, Ferreira, E, Fransson, E, Van Der Heijden, FMMA, Holzman, CB, Kim, JJ, Khashan, AS, Kirkwood, BR, Kuijpers, HJH, Lahti-Pulkkinen, M, Mason, D, Misra, D, Niemi, M, Nordeng, HME, Peacock, JL, Pickett, KE, Prady, SL, Premji, SS, Räikkönen, K, Rubertsson, C, Sahingoz, M, Shaikh, K, Silver, RK, Slaughter-Acey, J, Soremekun, S, Stein, DJ, Sundström-Poromaa, I, Sutter-Dallay, AL, Tiemeier, H, Uguz, F, Varela, P, Vrijkotte, TGM, Winterfeld, U, Zar, HJ, Zervas, IM, Prins, JB, Pop-Purceleanu, M & Roeleveld, N 2021, 'Associations between Maternal Depression, Antidepressant Use during Pregnancy, and Adverse Pregnancy Outcomes: An Individual Participant Data Meta-analysis', Obstetrics and Gynecology, vol. 138, no. 4, pp. 633-646. https://doi.org/10.1097/AOG.0000000000004538

Associations between Maternal Depression, Antidepressant Use during Pregnancy, and Adverse Pregnancy Outcomes: An Individual Participant Data Meta-analysis. / Vlenterie, Richelle; Van Gelder, Marleen M.H.J.; Anderson, H. Ross et al.
In: Obstetrics and Gynecology, Vol. 138, No. 4, 01.10.2021, p. 633-646.

Research output: Contribution to journal › Review article › peer-review

TY - JOUR

T1 - Associations between Maternal Depression, Antidepressant Use during Pregnancy, and Adverse Pregnancy Outcomes

T2 - An Individual Participant Data Meta-analysis

AU - Vlenterie, Richelle

AU - Van Gelder, Marleen M.H.J.

AU - Anderson, H. Ross

AU - Andersson, Liselott

AU - Broekman, Birit F.P.

AU - Dubnov-Raz, Gal

AU - El Marroun, Hanan

AU - Ferreira, Ema

AU - Fransson, Emma

AU - Van Der Heijden, Frank M.M.A.

AU - Holzman, Claudia B.

AU - Kim, J. Jo

AU - Khashan, Ali S.

AU - Kirkwood, Betty R.

AU - Kuijpers, Harold J.H.

AU - Lahti-Pulkkinen, Marius

AU - Mason, Dan

AU - Misra, Dawn

AU - Niemi, Maria

AU - Nordeng, Hedvig M.E.

AU - Peacock, Janet L.

AU - Pickett, Kate E.

AU - Prady, Stephanie L.

AU - Premji, Shahirose S.

AU - Räikkönen, Katri

AU - Rubertsson, Christine

AU - Sahingoz, Mine

AU - Shaikh, Kiran

AU - Silver, Richard K.

AU - Slaughter-Acey, Jaime

AU - Soremekun, Seyi

AU - Stein, Dan J.

AU - Sundström-Poromaa, Inger

AU - Sutter-Dallay, Anne Laure

AU - Tiemeier, Henning

AU - Uguz, Faruk

AU - Varela, Pinelopi

AU - Vrijkotte, Tanja G.M.

AU - Winterfeld, Ursula

AU - Zar, Heather J.

AU - Zervas, Iannis M.

AU - Prins, Judith B.

AU - Pop-Purceleanu, Monica

AU - Roeleveld, Nel

PY - 2021/10/1

Y1 - 2021/10/1

N2 - OBJECTIVE:To evaluate the associations of depressive symptoms and antidepressant use during pregnancy with the risks of preterm birth, low birth weight, small for gestational age (SGA), and low Apgar scores.DATA SOURCES:MEDLINE, EMBASE, ClinicalTrials.gov, and PsycINFO up to June 2016.METHODS OF STUDY SELECTION:Data were sought from studies examining associations of depression, depressive symptoms, or use of antidepressants during pregnancy with gestational age, birth weight, SGA, or Apgar scores. Authors shared the raw data of their studies for incorporation into this individual participant data meta-analysis.TABULATION, INTEGRATION, AND RESULTS:We performed one-stage random-effects meta-analyses to estimate odds ratios (ORs) with 95% CIs. The 215 eligible articles resulted in 402,375 women derived from 27 study databases. Increased risks were observed for preterm birth among women with a clinical diagnosis of depression during pregnancy irrespective of antidepressant use (OR 1.6, 95% CI 1.2-2.1) and among women with depression who did not use antidepressants (OR 2.2, 95% CI 1.7-3.0), as well as for low Apgar scores in the former (OR 1.5, 95% CI 1.3-1.7), but not the latter group. Selective serotonin reuptake inhibitor (SSRI) use was associated with preterm birth among women who used antidepressants with or without restriction to women with depressive symptoms or a diagnosis of depression (OR 1.6, 95% CI 1.0-2.5 and OR 1.9, 95% CI 1.2-2.8, respectively), as well as with low Apgar scores among women in the latter group (OR 1.7, 95% CI 1.1-2.8).CONCLUSION:Depressive symptoms or a clinical diagnosis of depression during pregnancy are associated with preterm birth and low Apgar scores, even without exposure to antidepressants. However, SSRIs may be independently associated with preterm birth and low Apgar scores.SYSTEMATIC REVIEW REGISTRATION:PROSPERO, CRD42016035711.

AB - OBJECTIVE:To evaluate the associations of depressive symptoms and antidepressant use during pregnancy with the risks of preterm birth, low birth weight, small for gestational age (SGA), and low Apgar scores.DATA SOURCES:MEDLINE, EMBASE, ClinicalTrials.gov, and PsycINFO up to June 2016.METHODS OF STUDY SELECTION:Data were sought from studies examining associations of depression, depressive symptoms, or use of antidepressants during pregnancy with gestational age, birth weight, SGA, or Apgar scores. Authors shared the raw data of their studies for incorporation into this individual participant data meta-analysis.TABULATION, INTEGRATION, AND RESULTS:We performed one-stage random-effects meta-analyses to estimate odds ratios (ORs) with 95% CIs. The 215 eligible articles resulted in 402,375 women derived from 27 study databases. Increased risks were observed for preterm birth among women with a clinical diagnosis of depression during pregnancy irrespective of antidepressant use (OR 1.6, 95% CI 1.2-2.1) and among women with depression who did not use antidepressants (OR 2.2, 95% CI 1.7-3.0), as well as for low Apgar scores in the former (OR 1.5, 95% CI 1.3-1.7), but not the latter group. Selective serotonin reuptake inhibitor (SSRI) use was associated with preterm birth among women who used antidepressants with or without restriction to women with depressive symptoms or a diagnosis of depression (OR 1.6, 95% CI 1.0-2.5 and OR 1.9, 95% CI 1.2-2.8, respectively), as well as with low Apgar scores among women in the latter group (OR 1.7, 95% CI 1.1-2.8).CONCLUSION:Depressive symptoms or a clinical diagnosis of depression during pregnancy are associated with preterm birth and low Apgar scores, even without exposure to antidepressants. However, SSRIs may be independently associated with preterm birth and low Apgar scores.SYSTEMATIC REVIEW REGISTRATION:PROSPERO, CRD42016035711.

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U2 - 10.1097/AOG.0000000000004538

DO - 10.1097/AOG.0000000000004538

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C2 - 34623076

AN - SCOPUS:85118286908

SN - 0029-7844

VL - 138

SP - 633

EP - 646

JO - Obstetrics and Gynecology

JF - Obstetrics and Gynecology

IS - 4

ER -

Associations between Maternal Depression, Antidepressant Use during Pregnancy, and Adverse Pregnancy Outcomes: An Individual Participant Data Meta-analysis

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