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).
  
  
  CONCLUSIONS
  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. LEVEL OF EVIEDENCE:: II.
authors.affiliation: Laboratory of Clinical Pharmacology, Copenhagen University Hospital Rigshospitalet, the Department of Clinical Pharmacology, Bispebjerg Hospital, the Mental Health Centre Copenhagen, and the Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Jon Trærup
authors.initials: JT
authors.lastname: Andersen
authors.forename: Nadia Lyhne
authors.initials: NL
authors.lastname: Andersen
authors.forename: Henrik
authors.initials: H
authors.lastname: Horwitz
authors.forename: Henrik Enghusen
authors.initials: HE
authors.lastname: Poulsen
authors.forename: Espen
authors.initials: E
authors.lastname: Jimenez-Solem
mesh_terms: D000022:Abortion, Spontaneous / Q000139:chemically induced* / Q000453:epidemiology; D000328:Adult; D015331:Cohort Studies; D016001:Confidence Intervals; D003718:Denmark; D003866:Depressive Disorder / Q000175:diagnosis / Q000188:drug therapy*; D005260:Female; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000188:drug therapy*; D011256:Pregnancy Outcome; D011261:Pregnancy Trimester, First; D016016:Proportional Hazards Models; D012016:Reference Values; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D017367:Selective Serotonin Reuptake Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D055815:Young Adult
chemical_list: D017367:Selective Serotonin Reuptake Inhibitors