Many women with depression express concern that the use of antidepressants will increase the risk of miscarriage.
A paper by Kjaersgaard and colleagues opens in a new window reported on over a million pregnancies using the Danish Birth Registry to explore the question of whether exposure to antidepressants, specifically SSRIs (Selective Serotonin Reuptake Inhibitors), and/or depression increased the risk of spontaneous abortion, also known as miscarriage. This is the first study of its magnitude to explore this important question. The results are reassuring in that they indicate SSRIs do not increase the risk for miscarriage, however women with mood disorders appear to have an increased risk of spontaneous abortion.
Overall, use of antidepressants, although statistically significant, actually very minimally increase the risk of miscarriage (RR 1.14). When the authors compared women with untreated depression to those on antidepressants, there was no increased risk of miscarriage. Individual SSRIs were systematically reviewed, and none increased the risk of miscarriage.
This indicates that women with depression who are treated with any SSRI have no higher risk of miscarriage opens in a new window than women with depression who remain untreated. Several recent papers have had similar findings opens in a new window.
The results of this new paper are highly reassuring that SSRIs do not specifically increase the risk of miscarriage. However, it does indicate depression inherently increases the risk for spontaneous miscarriage. The cause of this risk has not yet been fully delineated, but may be intrinsic to depression itself, or may be secondary to behaviors engaged in more often with depression (such as: alcohol, tobacco, less prenatal vitamins, less nutritious diet etc.).
The study limitations included inability to control for severity of illness and for additional confounding variables.
Maximizing health, minimizing depressive symptoms as early as possible in advance of pregnancy will optimize wellness, while also putting you in the best position for an upcoming pregnancy – this paper further supports my belief that a happy, healthy woman leads to happy, healthy mom and baby.