Antidepressants Linked to Miscarriage Risk
Researchers See Possible Connection Between SSRIs and Miscarriages
In an accompanying editorial, Adrienne Einarson, assistant director of the Motherisk Program at The Hospital for Sick Children, writes that there is no "gold standard for studying the safety of drugs during pregnancy, because all methods have strengths and limitations." However, she notes she encountered similar findings in her own research. "Clearly, this study cannot make any definitive conclusions as to whether antidepressants increase the risk of spontaneous abortion."
David L. Keefe, MD, is a psychiatrist and chairman of the department of obstetrics and gynecology at New York University Langone Medical Center. Keefe cautions that there is no need to change treatment recommendations.
"The strength of the study is that it used a large sample size. The other strength is that they used a database to determine if women actually took the medication, so they didn't use individual recall, which can be biased," Keefe tells WebMD. "But they didn't control for the other factors that can also contribute to miscarriage."
Keefe says that women who use antidepressants tend to be older, smoke, and are obese, all factors that can contribute to miscarriage and also factors that may be seen among women with depression. "You need to control for age, smoking, and weight and then see if this association still holds up."
"The depression itself might increase the risk of miscarriage because of the stress on the body," he says. "This is the first paper I've seen to claim an association, but I'm not convinced. There's a lot more work to be done."
Drug Company Perspective
"Our medical team has not completed its review of the Canadian Medical Association Journal article and therefore it would be premature for us to comment on this particular study," says GlaxoSmithKline spokeswoman Sarah Alspach, in an email to WebMD. GlaxoSmithKline is the maker of Paxil.
"It is unfortunate," says Alspach, "but approximately 10% to 15% of all confirmed pregnancies end in miscarriage before 20 weeks. [Paxil] is approved for use in adults with depression, and has shown a clear clinical benefit for those patients. The prescribing information contains information and warnings about the use of [Paxil] during pregnancy, and advises that doctors should only prescribe [Paxil] if the potential benefit outweighs the potential risk. Globally, GSK [GlaxoSmithKline] proactively monitors reports of adverse events experienced by people taking its medicines and updates the prescribing information as appropriate when new information is developed."
WebMD also contacted Pfizer, the maker of Effexor. "Pfizer will need to review this study in detail until we can provide any further comment," Pfizer spokesperson MacKay Jimeson tells WebMD. "In the UK, there is no adequate data for the use of [Effexor] in pregnant women. If patients or their carers are concerned about any aspect of their medication, they should consult their doctor immediately."