Journal article
First trimester antidepressant use and miscarriage: a comprehensive analysis in the Clinical Practice Research Datalink GOLD
British journal of general practice, v 75(761), pp 843-852
07 Aug 2025
PMID: 40774797
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Background Antidepressant prescribing during pregnancy is rising but uncertainties remain surrounding safety. Evidence relating to antidepressant use during pregnancy and miscarriage ranges in quality. Aim To investigate the association between first trimester antidepressant use and miscarriage. Design and setting Population-based cohort study in the UK Clinical Practice Research Datalink (CPRD) GOLD. Methods We identified pregnancies in the CPRD GOLD Pregnancy Register between 1996-2018. Pregnancies with prescriptions of antidepressants overlapping with first trimester were defined as 'exposed' and were compared to unexposed using Cox models, calculating adjusted hazard ratios (aHR) and absolute risk of miscarriage adjusted for confounders including depression, anxiety, smoking, and other health, lifestyle, and obstetric factors. Results Among the 1,021,384 eligible pregnancies, 73,540 were prescribed antidepressants in trimester one (7.2%); 14.7% antidepressant prescribed pregnancies ended in miscarriage versus 12.4% of those not prescribed antidepressants. Antidepressant use during trimester one was associated with miscarriage in the unadjusted models (HR 1.21, 95% confidence interval (CI) 1.19-1.23), which attenuated following adjustment for covariates (aHR 1.04, 95%CI 1.02-1.06). These findings translated to an absolute risk adjusted for confounders of 13.1% (95%CI 13.0-13.2) among unexposed and 13.6% (95%CI 13.3-13.8) among exposed. Among those taking antidepressants in the three months prior to pregnancy and into trimester one, the risk of miscarriage was the same as among unexposed (aHR 1.00, 95%CI 0.98-1.03). Conclusion First trimester antidepressant use was associated with a small, clinically insignificant increased risk of miscarriage, with no evidence suggesting taking antidepressants before pregnancy and into first trimester increases the risk of miscarriage.
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Details
- Title
- First trimester antidepressant use and miscarriage: a comprehensive analysis in the Clinical Practice Research Datalink GOLD
- Creators
- Florence Zoe Martin - University of BristolPaul C Madley-Dowd - University of BristolViktor H Ahlqvist - Aarhus UniversityGemma C Sharp - University of ExeterKayleigh E Easey - University of BristolBrian K Lee - Drexel UniversityAbigail Merriel - University of LiverpoolDheeraj Rai - University of BristolHarriet Forbes - University of Bristol
- Publication Details
- British journal of general practice, v 75(761), pp 843-852
- Publisher
- Royal College of General Practitioners
- Number of pages
- 11
- Grant note
- National Institute for Health and Care Research (NIHR): G01558 NIHR, Department of Health and Social Care: NIHR302530 MRC - MRCUniversity of Bristol: MC_UU_00011/1, MC_UU_00011/3, MC_UU_00011/7
Florence Z Martin was funded by the Wellcome Trust (grant reference: 218495/Z/19/Z) . Dheeraj Rai, Brian K Lee, and Harriet Forbes acknowledge support from the National Institutes of Health (reference number: 1R01NS107607) . Gemma C Sharp was supported by a Medical Research Council (MRC) grant (reference number: MR/S009310/1) . Kayleigh E Easey is financially supported by Bristol City Council 'Understanding and Evaluating Impact: Family Hubs Perinatal Mental Health and Wellbeing Workstream' (grant reference number: G01558) . Abi Merriel was funded by the National Institute for Health and Care Research (NIHR) for this research project (NIHR Advanced Fellowship reference: NIHR302530) . The views expressed in this publication are those of the author (s) and not necessarily those of the NHS, NIHR, Department of Health and Social Care, MRC, or the Wellcome Trust. Florence Z Martin, Paul C Madley-Dowd, Viktor H Ahlqvist, Kayleigh E Easey, Gemma C Sharp, and Dheeraj Rai are members of the UK MRC Integrative Epidemiology Unit, which is funded by the MRC (reference numbers: MC_UU_00011/1, MC_UU_00011/3, and MC_UU_00011/7) and the University of Bristol.
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Epidemiology and Biostatistics
- Web of Science ID
- WOS:001620257200001
- Scopus ID
- 2-s2.0-105023296432
- Other Identifier
- 991022074079804721
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- Collaboration types
- Domestic collaboration
- International collaboration
- Web of Science research areas
- Primary Health Care