Use of antidepressants and association with elective termination of pregnancy: population based case-control study

BJOG. 2015 Nov;122(12):1618-24. doi: 10.1111/1471-0528.13164. Epub 2014 Nov 14.

Abstract

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.

Design: Case-control study using data from national registers.

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

Population: 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.

Main outcome measures: 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.

Conclusion: 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.

Keywords: Antidepressants; fetal anomaly; socio-economic disadvantage; termination of pregnancy.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Abortion, Induced / psychology*
  • Abortion, Induced / statistics & numerical data
  • Adult
  • Antidepressive Agents / administration & dosage*
  • Antidepressive Agents, Tricyclic / administration & dosage*
  • Case-Control Studies
  • Denmark / epidemiology
  • Depression / drug therapy*
  • Depression / epidemiology
  • Depression / etiology
  • Drug Administration Schedule
  • Female
  • Finland / epidemiology
  • Humans
  • Maternal Age
  • Mianserin / administration & dosage
  • Mianserin / analogs & derivatives*
  • Mirtazapine
  • Norway / epidemiology
  • Pregnancy
  • Risk Factors
  • Serotonin Uptake Inhibitors / administration & dosage*
  • Social Class
  • Ultrasonography, Prenatal / statistics & numerical data*

Substances

  • Antidepressive Agents
  • Antidepressive Agents, Tricyclic
  • Serotonin Uptake Inhibitors
  • Mianserin
  • Mirtazapine