Association Between Anti-Depressant Use And Spontaneous Abortions: A Systematic Review And Meta-Analysis Of Observational Studies

Abstract

Background: Various studies have assessed the association between anti-depressant use and spontaneous abortion. However, no conclusive evidence could be generated across studies as they reported mixed results. Hence, this review was done to determine the association of antidepressant medications on spontaneous abortions.

Methods: Search was done in Medline, EMBASE, PubMed Central, ScienceDirect, Google Scholar and Cochrane library. The search was performed from inception until May 2024. We carried out meta-analysis with random-effects model and reported pooled odds ratio (OR) with 95% confidence interval (CI).

Results: We identified 32 studies with nearly 5.5 million participants. The pooled OR was 1.27 (95%CI 1.19-1.34; I²=81.9%). Subgroup analysis based on type of antidepressants revealed that mothers taking selective serotonin reuptake inhibitors (SSRIs) had pooled OR of 1.35 (95%CI 1.20-1.52; I²=94.5%), and those taking serotonin and norepinephrine reuptake inhibitors (SNRIs) had pooled OR of 1.75 (95%CI 1.04-2.96; I²=96.2%). In contrast, the association with tricyclic antidepressants (TCAs) was non-significant (pooled OR=2.44; 95%CI 0.98-6.06; I²=92%). For women with depression and antidepressant exposure compared to women with depression but without antidepressant exposure, pooled OR was 1.25 (95%CI 0.92-1.69; I²=94.4%), indicating no significant difference in the spontaneous abortion rate between these groups. Subgroup analysis showed that SSRIs were associated with 9% lower risk of spontaneous abortion (pooled OR=0.91; 95%CI 0.86-0.95; I²=0%).

Conclusions: Antidepressant intake during pregnancy is associated with moderately increased risk of spontaneous abortion, while there was no association compared to women with depression but without antidepressant exposure.