Use of antidepressants and association with elective termination of pregnancy: population based case-control study.
OBJECTIVE
To assess whether the use of selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants, mirtazapine, venlafaxine or other antidepressants is associated with late elective termination of pregnancy.


METHODS
Case-control study using data from national registers.


METHODS
Denmark, Finland, and Norway during the period 1996-2007.


METHODS
A total of 14,902 women were included as cases and 148,929 women were included as controls.


METHODS
Cases were women with elective termination of pregnancy at 12-23 weeks of gestation. Controls continued their pregnancy and were matched with cases on key factors.


METHODS
Association between antidepressant use during pregnancy and elective termination of pregnancy at 12-23 weeks of gestation for fetal anomalies, or for maternal ill health or socio-economic disadvantage.


RESULTS
At least one prescription of antidepressants was filled by 3.7% of the cases and 2.2% of the controls. Use of any type of antidepressant was associated with elective termination of pregnancy for maternal ill health or socio-economic disadvantage (odds ratio, OR 2.3; 95% confidence interval, 95% CI 2.0-2.5). Elective termination of pregnancy for fetal anomalies was associated with the use of mirtazapine (OR 2.2, 95% CI 1.1-4.5). There was no association between the use of any of the other antidepressants and elective termination of pregnancy for fetal anomalies.


CONCLUSIONS
The use of any type of antidepressants was associated with elective termination of pregnancy at 12-23 weeks for maternal ill health or socio-economic disadvantage, but not with terminations for fetal anomalies. Further studies need to confirm the findings concerning mirtazapine and termination of pregnancy for fetal anomalies.
Department of Medicine Solna, Centre for Pharmacoepidemiology, Karolinska Institutet, Stockholm, Sweden.
H
H
Kieler
Teratology Information Service, HUSLAB and Helsinki University Central Hospital, Helsinki, Finland.|Department of Clinical Pharmacology, Helsinki University, Helsinki, Finland.
H
H
Malm
Department of Medical Genetics, Helsinki University, Helsinki, Finland.
M
M
Artama
Division of Epidemiology, Department of Pharmacoepidemiology, Norwegian Institute of Public Health, Oslo, Norway.|Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
A
A
Engeland
Division of Epidemiology, Department of Pharmacoepidemiology, Norwegian Institute of Public Health, Oslo, Norway.
K
K
Furu
Nordic School of Public Health, Gothenburg, Sweden.|THL National Institute for Health and Welfare, Helsinki, Finland.
M
M
Gissler
Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark.
M
M
Nørgaard
Department of Medicine Solna, Centre for Pharmacoepidemiology, Karolinska Institutet, Stockholm, Sweden.|Division of Obstetrics and Gynecology, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
O
O
Stephansson
Centre of Public Health Sciences, School of Health Sciences, University of Iceland, Reykjavik, Iceland.|Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA.
U
U
Valdimarsdottir
Centre of Public Health Sciences, School of Health Sciences, University of Iceland, Reykjavik, Iceland.
H
H
Zoega
Department of Medicine Solna, Centre for Pharmacoepidemiology, Karolinska Institutet, Stockholm, Sweden.
B
B
Haglund
D000028:Abortion, Induced / Q000523:psychology* / Q000706:statistics & numerical data; D000328:Adult; D000928:Antidepressive Agents / Q000008:administration & dosage*; D000929:Antidepressive Agents, Tricyclic / Q000008:administration & dosage*; D016022:Case-Control Studies; D003718:Denmark / Q000453:epidemiology; D003863:Depression / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology; D004334:Drug Administration Schedule; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D008423:Maternal Age; D008803:Mianserin / Q000008:administration & dosage / Q000031:analogs & derivatives*; D000078785:Mirtazapine; D009664:Norway / Q000453:epidemiology; D011247:Pregnancy; D012307:Risk Factors; D017367:Selective Serotonin Reuptake Inhibitors / Q000008:administration & dosage*; D012923:Social Class; D016216:Ultrasonography, Prenatal / Q000706:statistics & numerical data*
D000928:Antidepressive Agents; D000929:Antidepressive Agents, Tricyclic; D008803:Mianserin; D000078785:Mirtazapine; D017367:Selective Serotonin Reuptake Inhibitors
Antidepressants; fetal anomaly; socio-economic disadvantage; termination of pregnancy