A new study assessed whether a class of antidepressants known as selective serotonin reuptake inhibitors (SSRIs) in early pregnancy is associated with miscarriage. They found that an increased risk of taking or discontinuing the medication. SSRIS include citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), Paroxetine (Paxil, Pexeva), and sertraline (Zoloft). The findings were published in the October edition of the journal Obstetrics & Gynecology by Danish researchers.
The study authors note that it is estimated that up to 15% of all women are affected with depressive symptoms during pregnancy. Untreated depression has previously been associated with preeclampsia (toxemia), preterm delivery, low birth weight infants, and miscarriage. A study found that women who suffered a miscarriage had a higher concentration of serotonin in the blood, compared with women giving birth; thus, there has been a great concern regarding treatment with SSRIs. From 1997 to 2017, the number of Danish women being treated with SSRIs during pregnancy has increased 16-fold; in the United States, up to 13% of pregnant women are treated with an SSRI in the first trimester (first three months of pregnancy).
The investigators conducted a nationwide study that reviewed all registered pregnancies in Denmark from 1997 to 2010. All births were identified using the Medical Birth Registry, and all records of therapeutic abortion or miscarriage were gathered from the National Hospital Register. Data on SSRI use were gathered from the National Prescription Register. The data was subjected to statistical analysis.
The researchers identified 1,279,840 pregnancies (911,569 births, 142,093 miscarriages, 226,178 therapeutic abortions). Among the 22,884 exposed to an SSRI during the first 35 days of pregnancy, 2,883 (12.6%)) ended in miscarriage compared to 11.1% among unexposed. The increased risk was 1.27-fold. Women who discontinued SSRI medication 3–12 months before pregnancy also had an increased risk of miscarriage (1.24-fold increased risk).
The authors concluded that women exposed to SSRIs during early pregnancy were at increased risk of miscarriage as were women who discontinued SSRI medication before pregnancy, and these risks were similar. Therefore, they recommended that treatment with SSRIs during pregnancy should not be discontinued as a result of fear of miscarriage.
The researchers are affiliated with: Laboratory of Clinical Pharmacology, Copenhagen University Hospital Rigshospitalet; the Department of Clinical Pharmacology, Bispebjerg Hospital; the Mental Health Centre Copenhagen; and the Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.