Utilisation en grossesse des antidépresseurs et les risques maternels associés : focus sur le diabète gestationnel et la dépression postpartum

Depression affects about 20% of women of childbearing age and about 5% to 15% of pregnant women. Anxiety disorders, often concomitant with maternal depression, are in the order of 15% during pregnancy. In recent years, gestational use of antidepressants has increased, despite the associated risks to mother and child reported in the literature. Maternal risks such as the risk of gestational diabetes and postpartum depression have been little studied with often contradictory results. In addition, data on the evolution over time of the prevalence of depression / anxiety and the use of antidepressants during pregnancy are very limited in the literature. The Quebec Pregnancy Cohort (QPC) was used for this research and the thesis was organized in three parts. In a first part, we carried out a descriptive study to determine the prevalence and the trends of use of antidepressants and maternal depression / anxiety during pregnancy. over the period from 1998 to 2015. We observed that the prevalence of antidepressants use during pregnancy has tripled, ranging from 2.2% in 1998 to 6.2% in 2015, while the prevalence of maternal depression / anxiety has increased by 1.3 (from 5% in 1998 to 7% in 2015).  The second part consisted of carrying out a study using the nested case-control design to assess whether the gestational use of antidepressants was associated with an increased risk of gestational diabetes. We have found that the use of antidepressants is associated with an increased risk of gestational diabetes (aOR = 1.19, 95% CI: 1.08-1.30) and particularly for venlafaxine (aOR = 1.27, 95% CI: 1.09-1.49) and amitriptyline (aOR = 1.52, 95% CI: 1.25-1.84). The third part consisted of a survival analysis to determine whether different trajectories of antidepressant use during pregnancy in women depressed before pregnancy could affect the risk of postpartum depression. Our results show that women exposed continuously during pregnancy (aHR = 1.69; 95% CI: 1.01-2.84), those exposed in the second / third trimester (aHR = 2.56; 95% CI: 1.33-4.90), and those with intermittent exposure (aHR = 2.41; 95% CI: 1.59-3.66) have a higher risk of postpartum depression than depressed pregnant women, not exposed during gestation. Conversely, those exposed only in the first trimester (aHR = 1.35; 95% CI: 0.81-2.25) were less at risk of postpartum depression compared to unexposed women. In conclusion, antidepressants are increasingly used in pregnancy and we have observed a moderate increase in the risk of gestational diabetes associated with their use, mainly for venlafaxine and amitriptyline. Regarding their real-life efficacy in preventing postpartum depression, we found no decreased risk for users in a cohort of women with prenatal depression. Nonetheless, despite some methodological limitations, these results reinforce the need for a personalized treatment approach for each pregnant woman with depression, in order to make the best choices for her health and that of the unborn child.

Keyphrases: Maternal depression, Antidepressants, Gestational diabetes, Postpartum depression, Maternal risks