SSRI Antidepressants in Pregnancy May Increase Risk of Miscarriage: Study

A new study suggests that certain types of antidepressants may increase the risk of miscarriage if used during early pregnancy, but even stopping use of the popular medications up to a year before getting pregnant may not help curtail the risk.

Side effects of antidepressants that are part of a class of medications known as selective serotonin reuptake inhibitors (SSRIs), which include blockbuster medications like Zoloft, Paxil, Prozac, Celexa, Lexapro and others, have previously been linked to an increased risk of birth defects and other problems when used during pregnancy. But this new research ties the class of medications to a 27% increased risk of miscarriage, suggesting that the effects of the drugs may extend into pregnancy even if women stop using the antidepressants long before they become pregnant.

In a study published this month in Obstetrics & Gynecology, researchers conducted a nationwide cohort study of pregnancies in Denmark from 1997 to 2010, involving 1,279,840 pregnancies.

The findings indicate that women who used an SSRI during the first 35 days of pregnancy had a 12.6% chance of losing their unborn child. That compares to only an 11.1% chance by women who were not exposed to an SSRI.

Researchers said the difference equates to about a 27% increased risk of miscarriage. However, women who discontinued SSRI treatment three to 12 months before pregnancy still had a 24% increased risk of miscarriage, compared to women who had not been on the drugs.

The findings suggest that whatever mechanism could link the use of SSRIs like Paxil and Zoloft to miscarriages does not abate quickly, and even women who stop using the drugs a year before they become pregnant still face an increased risk of losing their baby.

The study found that while the results suggest that there is a connection between the antidepressants and miscarriages, doctors may want to consider leaving patients on the drugs to battle their depression, since taking them off the drug does not appear to reduce the risk in a timely manner.

“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,” the researchers concluded. “Therefore, treatment with SSRIs during pregnancy should not be discontinued as a result of fear of miscarriage.”

SSRI Birth Defect Risks

Other studies have suggested potential risks associated with continuing to use SSRI antidepressants while pregnant, including a potential connection with the development of birth defects and malformations among children exposed to the drugs in utero.

In a study published in the British Medical Journal (BMJ) in January 2014, Canadian researchers found that SSRI antidepressants were associated with an increased risk of children being born with persistent pulmonary hypertension in newborns (PPHN).

The risk increased the later during pregnancy that the drug was used, according to the results, which argues for taking women off the drugs either before they plan to become pregnant or as soon as they find out that they are pregnant.

PPHN is a rare birth defect that results in babies being unable to adapt to breathing outside of the womb. They frequently require intensive care and the use of a mechanical ventilator to help them breathe. Severe cases of PPHN can result in multiple organ damage, brain damage and death.

In December 2011, the FDA issued a drug safety communication warning about the link between SSRI pregnancy use and PPHN. However, the federal drug regulators said that there was conflicting data and said the association was unclear. That was a rollback of a 2006 warning by the FDA, which indicated that pregnancy exposure to SSRIs were associated with an increased risk of PPHN.

Several years ago, GlaxoSmithKline faced hundreds of lawsuits over Paxil birth defects linked to PPHN, and the drug maker has settled most of those cases.

Now, Pfizer faces more than 400 Zoloft birth defect lawsuits from parents who say the company failed to warn them that taking the drug during pregnancy placed their unborn children at risk of PPHN and other severe health problems that are allegedly caused by use of the antidepressant during pregnancy.

Zoloft (sertraline) is one of the most widely prescribed medications in the United States, and has been used by tens of millions of individuals. However, use of Zoloft by pregnant women has been linked to a potential increased risk of serious and potentially life-threatening birth defects and malformation for children.

In November 2006, the FDA added warnings about a potential risk of PPHN from Zoloft and other newer antidepressants when taken after the 20th week of pregnancy. The side effects of Zoloft and other similar medications were linked to a six times greater risk of PPHN.

In June 2007, studies found an association between the use of antidepressants like Zoloft early in the pregnancy and a risk of abnormal skull development, gastrointestinal abnormality and brain defects.

In September 2009, another study published in the British Medical Journal found that SSRI antidepressants like Zoloft increase the risk of heart defects when taken during the first trimester, a time when many women do not even know they are pregnant.