Abstract
BackgroundWomen taking antidepressant or anti-anxiety medications during early pregnancy have high risks of non-live pregnancy outcomes, although the contribution of the underlying illnesses to these risks remains unclear. We examined the impacts of antenatal depression and anxiety and of commonly prescribed treatments on the risks of non-live pregnancy outcomes.MethodsWe identified all pregnancies and their outcome (live birth, perinatal death, miscarriage or termination) among women aged 15–45 years between 1990 and 2009 from a large primary care database in the United Kingdom. Women were grouped according to whether they had no history of depression and anxiety, a diagnosis of such illness prior to pregnancy, illness during pregnancy and illness during pregnancy with use of medication (stratified by medication type). Multinomial logistic regression models were used to compare risks of non-live outcomes among these groups, adjusting for major socio-demographic and lifestyle characteristics.ResultsAmong 512,574 pregnancies in 331,414 women, those with antenatal drug exposure showed the greatest increased risks for all non-live pregnancy outcomes, relative to those with no history of depression or anxiety, although women with prior (but not currently medicated) illness also showed modest increased risks. Compared with un-medicated antenatal morbidity, there was weak evidence of an excess risk in women taking tricyclic antidepressants, and stronger evidence for other medications.ConclusionsWomen with depression or anxiety have higher risks of miscarriage, perinatal death and decisions to terminate a pregnancy if prescribed psychotropic medication during early pregnancy than if not. Although underlying disease severity could also play a role, avoiding or reducing use of these drugs during early pregnancy may be advisable.
Highlights
[2] Prior research suggests that taking antidepressants during early pregnancy has adverse effects on pregnancy outcomes and neonatal health, [3] including increased risks of miscarriage [4,5,6,7,8,9] and perinatal death. [5,10] It has been suggested that women taking antidepressants during pregnancy are more likely to have a termination, [5,9,11] the majority of these studies have been small-scale and few have considered the contribution of the underlying mental health conditions which necessitate treatment to the observed effects
Whilst ethical approval is required for each study using The Health Improvement Network (THIN) data, direct consent from individual patients is not required under the United Kingdom (UK) Data Protection Act because all data are anonymised, such that individual patients as well as the names and specific locations of general practices are withheld from researchers
Pregnancies ending in terminations were more likely to be in younger women with a history of smoking and from socio-economically deprived groups whilst miscarriage was more common in older women, compared with pregnancies ending in live births
Summary
Data source and ethics statement We used data from The Health Improvement Network (THIN), a nationally representative database of computerised primary care medical records containing validated recordings of medical diagnoses, events, symptoms and drug prescriptions [24] collected at 446 general practices (primary health care units) throughout the UK. Statistical analyses Multinomial logistic regression models were used to obtain relative risk ratios (RRRs) for perinatal death, miscarriage and termination relative to live births in each of the seven exposure groups, compared with women without any indication of current or prior depression or anxiety. To determine whether the use of psychotropic medication was associated with an excess risk of each adverse pregnancy outcome compared with un-medicated depression or anxiety, we repeated our analyses excluding women without current depression or anxiety (i.e. we excluded the original referent group and group 1), so that RRRs were in reference to group 2 (a recording of depression or anxiety, but no prescriptions during the first trimester). All analyses were carried out using Stata SE 11.0 (Stata Corp., TX, USA) for Windows 2007 Enterprise Edition (Microsoft Corporation, Seattle, USA)
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
