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Antidepressants Linked to Miscarriage Risk

Researchers See Possible Connection Between SSRIs and Miscarriages
By Katrina Woznicki
WebMD Health News
Reviewed by Laura J. Martin, MD

June 2, 2010 -- A Canadian study of more than 5,000 women shows an association between taking antidepressants, particularly the selective serotonin reuptake inhibitors (SSRIs) such as Paxil, Prozac, and Zoloft, and an increased risk for miscarriage. But researchers caution that this association does not imply a cause-and-effect relationship.

The study is published in the June issue of the Canadian Medical Association Journal.

Researchers from the University of Montreal and the CHU Sainte-Justine Mother and Child University Hospital in Montreal analyzed population data from the Quebec Pregnancy Registry. They identified 69,742 pregnant women from the registry, including 5,124 women who had had a miscarriage during the first 20 weeks of pregnancy; 51,240 women who did not have miscarriages served as a comparison group in the study.

The women ranged in ages from 15 to 45. The data were collected between 1998 and 2003.

Among those who had miscarried, 5.5% had taken antidepressants. Compared with the women who had not miscarried, those who had were more likely to be older, live in an urban environment, be recipients of social assistance, have a diagnosis of depression or anxiety, have visited a psychiatrist in the year prior to pregnancy, have had longer duration of exposure to antidepressants, and have had diabetes and/or asthma.

Miscarriage Risk

Overall, the analysis showed:

  • A 68% increased risk in miscarriage in pregnant women using any class of antidepressant drugs compared with women who had never used antidepressants.
  • A 61% increased risk among those who used SSRIs.
  • A 75% increased risk of miscarriage associated with the SSRI Paxil. 
  • A 19% increased risk of miscarriage among those who had a history of depression.

There was also an independent risk associated with Effexor, part of the class of antidepressants called serotonin norepinephrine reuptake inhibitors.

"Animal studies had shown that rats were aborting more frequently when they were using antidepressants," Anick Bérard, PhD, director of the research unit on medications and pregnancy at the University of Montreal and senior study author, tells WebMD in an email. "No human study had looked at classes, types, and dosages of antidepressants and the risk of spontaneous abortions."

Although any kind of exact biological mechanism remains unclear, Bérard says "it is believed that antidepressants have a mediated serotonin effect that would put pressure on the uterus at a very early stage of pregnancy."More research would be needed to flesh out any biological connection.

According to the researchers, antidepressants are widely used in pregnancy and up to 3.7% of women will use them at some point during the first trimester. However, discontinuing treatment can cause problems since depression can put both the mother and baby at risk. In the U.S., there are about 6 million pregnancies every year, and there are 2 million pregnancy losses including about 600,000 due to miscarriage in the first 20 weeks of gestation.

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