Reassuring Data on Antidepressant Use in Pregnancy

Megan Brooks

November 22, 2019

PHILADELPHIA — Time to conception can take longer for women using antidepressant medications, but the drugs have no impact on live birth rates or risk for miscarriage, according to new research funded by the National Institutes of Health.

Depression and antidepressant medication use is common in women trying to conceive, and this study provides a "reassuring message," said Lindsey Sjaarda, PhD, from the Eunice Kennedy Shriver National Institute of Child Health & Human Development.

Sjaarda and her colleagues assessed the association between preconception-measured antidepressant exposure and time to pregnancy, pregnancy loss, and live birth from a cohort of women in the Effects of Aspirin in Gestation and Reproduction Trial.

At study enrolment and at each conception cycle and pregnancy visit (weeks 4 and 8), the urine of the 1218 study participants was assessed for fluoxetine, sertraline, escitalopram, citalopram, trazadone, nefazodone, etoperidone, and tricyclic antidepressants and related compounds.

Evidence of antidepressant use prior to conception — at enrollment or at the last cycle prior to conception— was found in 183 (15%) of the 1218 women participating in the study.

Antidepressant exposure before conception was associated with a somewhat lower probability of achieving a pregnancy within one menstrual cycle (odds ratio, 0.77; 95% confidence interval [CI], 0.61 - 0.99).

However, there was no difference in the overall live birth rate between women exposed and not exposed to antidepressants (48% vs 56%; risk ratio [RR], 0.91; 95% CI, 0.77 - 1.08).

In the 785 pregnancies confirmed with human chorionic gonadotropin levels, there was no association between preconception exposure or nonexposure and pregnancy loss (25% vs 24%; RR, 1.04; 95% CI, 0.73 - 1.50).

"Women using selective serotonin reuptake inhibitors [SSRIs] while trying to conceive had a somewhat longer time to pregnancy," so such women should be "prepared for this possibility." Sjaarda said here at the American Society for Reproductive Medicine 2019 Scientific Congress.

But it is important to put this finding in context. "Other factors — for example, correctly timing intercourse with ovulation — have a stronger influence on how quickly couples without known fertility problems become pregnant," she said.

Benefits Outweigh Risks

These data "substantially" fill gaps in this area of research, with "quality objective exposure measurements and inclusion of early pregnancy and miscarriage detection," and demonstrate a "relatively reassuring message for SSRIs overall," said Sjaarda.

"We hope women and their physicians can use this study to make more informed, evidence-based decisions about SSRI use while trying to become pregnant," she added.

"Patients may be concerned about being on an antidepressant during pregnancy, so this study is reassuring," said Eve Feinberg, MD, from Northwestern Medicine in Chicago, who is vice president of the Society for Reproductive Endocrinology and Infertility.

"I generally will keep patients on their antidepressant," she told Medscape Medical News.

She said she outlines the risks and benefits for her patients and explains that "a healthy mom equals a healthy pregnancy, with less risk of postpartum depression."

American Society for Reproductive Medicine (ASRM) 2019 Scientific Congress: Abstract O-1. Presented October 14, 2019.

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