Exposure to Selective Serotonin Reuptake Inhibitors in Early Pregnancy and the Risk of Miscarriage

Jon Thor Trærup Andersen; Nadia Lyhne Andersen; Henrik Horwitz; Henrik Enghusen Poulsen; Espen Jimenez-Solem

doi:10.1097/aog.0000000000000447

Exposure to Selective Serotonin Reuptake Inhibitors in Early Pregnancy and the Risk of Miscarriage

Jon Thor Trærup Andersen, Nadia Lyhne Andersen, Henrik Horwitz, Henrik Enghusen Poulsen, Espen Jimenez-Solem

53 Citations (Scopus)

Abstract

OBJECTIVE: To investigate whether exposure to selective serotonin reuptake inhibitors (SSRIs) in early pregnancy is associated with miscarriage.

METHODS: This was a nationwide cohort study identifying all registered pregnancies in Denmark from 1997 to 2010. All births were identified using the Medical Birth Registry, and all records of induced abortion or miscarriage were gathered from the National Hospital Register. Data on SSRI use were gathered from the National Prescription Register. Cox proportional hazard regression models were used to calculate the hazard of miscarriage in women exposed to an SSRI in early pregnancy and the hazard of miscarriage in women discontinuing treatment before pregnancy.

RESULTS: We identified 1,279,840 pregnancies (911,569 births, 142,093 miscarriages, 226,178 induced abortions). Of the 22,884 exposed to an SSRI during the first 35 days of pregnancy, 12.6% (2,883) ended in miscarriage compared with 11.1% among unexposed. The adjusted hazard ratio of having a miscarriage after exposure to an SSRI was 1.27 (95% confidence interval [CI] 1.22-1.33) compared with unexposed. Women discontinuing SSRI treatment 3-12 months before pregnancy also had an increased hazard ratio of having a miscarriage compared to unexposed (1.24, 95% CI 1.18-1.30).

CONCLUSION: Women exposed to SSRIs during early pregnancy were at increased risk of miscarriage as were women discontinuing SSRI treatment before pregnancy, and these risks were similar. Therefore, treatment with SSRIs during pregnancy should not be discontinued as a result of fear of miscarriage.

Original language	English
Journal	Obstetrics and Gynecology
Volume	124
Issue number	4
Pages (from-to)	655-661
Number of pages	7
ISSN	0029-7844
DOIs	https://doi.org/10.1097/aog.0000000000000447
Publication status	Published - 10 Oct 2014

Keywords

Abortion, Spontaneous
Adult
Cohort Studies
Confidence Intervals
Denmark
Depressive Disorder
Female
Humans
Incidence
Infant, Newborn
Pregnancy
Pregnancy Complications
Pregnancy Outcome
Pregnancy Trimester, First
Proportional Hazards Models
Reference Values
Registries
Retrospective Studies
Risk Assessment
Serotonin Uptake Inhibitors
Young Adult

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10.1097/aog.0000000000000447

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title = "Exposure to Selective Serotonin Reuptake Inhibitors in Early Pregnancy and the Risk of Miscarriage",

abstract = "OBJECTIVE: To investigate whether exposure to selective serotonin reuptake inhibitors (SSRIs) in early pregnancy is associated with miscarriage.METHODS: This was a nationwide cohort study identifying all registered pregnancies in Denmark from 1997 to 2010. All births were identified using the Medical Birth Registry, and all records of induced abortion or miscarriage were gathered from the National Hospital Register. Data on SSRI use were gathered from the National Prescription Register. Cox proportional hazard regression models were used to calculate the hazard of miscarriage in women exposed to an SSRI in early pregnancy and the hazard of miscarriage in women discontinuing treatment before pregnancy.RESULTS: We identified 1,279,840 pregnancies (911,569 births, 142,093 miscarriages, 226,178 induced abortions). Of the 22,884 exposed to an SSRI during the first 35 days of pregnancy, 12.6% (2,883) ended in miscarriage compared with 11.1% among unexposed. The adjusted hazard ratio of having a miscarriage after exposure to an SSRI was 1.27 (95% confidence interval [CI] 1.22-1.33) compared with unexposed. Women discontinuing SSRI treatment 3-12 months before pregnancy also had an increased hazard ratio of having a miscarriage compared to unexposed (1.24, 95% CI 1.18-1.30).CONCLUSION: Women exposed to SSRIs during early pregnancy were at increased risk of miscarriage as were women discontinuing SSRI treatment before pregnancy, and these risks were similar. Therefore, treatment with SSRIs during pregnancy should not be discontinued as a result of fear of miscarriage.",

keywords = "Abortion, Spontaneous, Adult, Cohort Studies, Confidence Intervals, Denmark, Depressive Disorder, Female, Humans, Incidence, Infant, Newborn, Pregnancy, Pregnancy Complications, Pregnancy Outcome, Pregnancy Trimester, First, Proportional Hazards Models, Reference Values, Registries, Retrospective Studies, Risk Assessment, Serotonin Uptake Inhibitors, Young Adult",

author = "Andersen, {Jon Thor Tr{\ae}rup} and Andersen, {Nadia Lyhne} and Henrik Horwitz and Poulsen, {Henrik Enghusen} and Espen Jimenez-Solem",

year = "2014",

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doi = "10.1097/aog.0000000000000447",

language = "English",

volume = "124",

pages = "655--661",

journal = "Obstetrics and Gynecology",

issn = "0029-7844",

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TY - JOUR

T1 - Exposure to Selective Serotonin Reuptake Inhibitors in Early Pregnancy and the Risk of Miscarriage

AU - Andersen, Jon Thor Trærup

AU - Andersen, Nadia Lyhne

AU - Horwitz, Henrik

AU - Poulsen, Henrik Enghusen

AU - Jimenez-Solem, Espen

PY - 2014/10/10

Y1 - 2014/10/10

N2 - OBJECTIVE: To investigate whether exposure to selective serotonin reuptake inhibitors (SSRIs) in early pregnancy is associated with miscarriage.METHODS: This was a nationwide cohort study identifying all registered pregnancies in Denmark from 1997 to 2010. All births were identified using the Medical Birth Registry, and all records of induced abortion or miscarriage were gathered from the National Hospital Register. Data on SSRI use were gathered from the National Prescription Register. Cox proportional hazard regression models were used to calculate the hazard of miscarriage in women exposed to an SSRI in early pregnancy and the hazard of miscarriage in women discontinuing treatment before pregnancy.RESULTS: We identified 1,279,840 pregnancies (911,569 births, 142,093 miscarriages, 226,178 induced abortions). Of the 22,884 exposed to an SSRI during the first 35 days of pregnancy, 12.6% (2,883) ended in miscarriage compared with 11.1% among unexposed. The adjusted hazard ratio of having a miscarriage after exposure to an SSRI was 1.27 (95% confidence interval [CI] 1.22-1.33) compared with unexposed. Women discontinuing SSRI treatment 3-12 months before pregnancy also had an increased hazard ratio of having a miscarriage compared to unexposed (1.24, 95% CI 1.18-1.30).CONCLUSION: Women exposed to SSRIs during early pregnancy were at increased risk of miscarriage as were women discontinuing SSRI treatment before pregnancy, and these risks were similar. Therefore, treatment with SSRIs during pregnancy should not be discontinued as a result of fear of miscarriage.

AB - OBJECTIVE: To investigate whether exposure to selective serotonin reuptake inhibitors (SSRIs) in early pregnancy is associated with miscarriage.METHODS: This was a nationwide cohort study identifying all registered pregnancies in Denmark from 1997 to 2010. All births were identified using the Medical Birth Registry, and all records of induced abortion or miscarriage were gathered from the National Hospital Register. Data on SSRI use were gathered from the National Prescription Register. Cox proportional hazard regression models were used to calculate the hazard of miscarriage in women exposed to an SSRI in early pregnancy and the hazard of miscarriage in women discontinuing treatment before pregnancy.RESULTS: We identified 1,279,840 pregnancies (911,569 births, 142,093 miscarriages, 226,178 induced abortions). Of the 22,884 exposed to an SSRI during the first 35 days of pregnancy, 12.6% (2,883) ended in miscarriage compared with 11.1% among unexposed. The adjusted hazard ratio of having a miscarriage after exposure to an SSRI was 1.27 (95% confidence interval [CI] 1.22-1.33) compared with unexposed. Women discontinuing SSRI treatment 3-12 months before pregnancy also had an increased hazard ratio of having a miscarriage compared to unexposed (1.24, 95% CI 1.18-1.30).CONCLUSION: Women exposed to SSRIs during early pregnancy were at increased risk of miscarriage as were women discontinuing SSRI treatment before pregnancy, and these risks were similar. Therefore, treatment with SSRIs during pregnancy should not be discontinued as a result of fear of miscarriage.

KW - Abortion, Spontaneous

KW - Adult

KW - Cohort Studies

KW - Confidence Intervals

KW - Denmark

KW - Depressive Disorder

KW - Female

KW - Humans

KW - Incidence

KW - Infant, Newborn

KW - Pregnancy

KW - Pregnancy Complications

KW - Pregnancy Outcome

KW - Pregnancy Trimester, First

KW - Proportional Hazards Models

KW - Reference Values

KW - Registries

KW - Retrospective Studies

KW - Risk Assessment

KW - Serotonin Uptake Inhibitors

KW - Young Adult

U2 - 10.1097/aog.0000000000000447

DO - 10.1097/aog.0000000000000447

M3 - Journal article

C2 - 25198261

SN - 0029-7844

VL - 124

SP - 655

EP - 661

JO - Obstetrics and Gynecology

JF - Obstetrics and Gynecology

IS - 4

ER -

Exposure to Selective Serotonin Reuptake Inhibitors in Early Pregnancy and the Risk of Miscarriage

Abstract

Keywords

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