Association between antidepressant use during pregnancy and miscarriage: a systematic review and meta-analysis
Review (29 studies; n=5,671,135) found no clear evidence that antidepressants increase risk of miscarriage (summary effect estimate: 1.16, 1.04 to 1.31; p=0.034, when comparing against unexposed individuals with maternal depression).
Source:
BMJ Open
SPS commentary:
Overall, when compared to unexposed individuals from the general population, the use of antidepressants during pregnancy was associated with an increased risk of miscarriage (summary effect estimate: 1.24, 95% CI 1.18 to 1.31, I2=69.2%; 29 studies). However, once stratified by maternal depression, the 95% confidence intervals almost spanned the null; the authors say this suggests the association is likely driven by confounding by indication.
The authors discuss the limitations of their study, noting there was high heterogeneity between the papers, the lack of available data to conduct a trimester-specific subgroup analysis, and the possibility of publication bias. They call for further observational studies with larger sample sizes and more robust confounding adjustment, and network meta-analyses to fully investigate the differing risk between antidepressant classes.