Gestational Exposure to Antidepressants and the Risk of Spontaneous Abortion: A Review

Broy, Perrine; Bérard, Anick

doi:10.2174/156720110790396508

Cited by 27 publications

(13 citation statements)

References 58 publications

(72 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…11 However, Broy and Bérard, who also included studies published in 2009, reported an increased risk of spontaneous abortion associated with the overall use of antidepressants, specifically paroxetine and venlafaxine. 12 Most of the above studies had limitations such as insufficient power; inefficient study design; potential misclassification of study outcome or exposure owing to maternal recall; lack of complete information on exposure including type, timing and dosage of antidepressant; and the inability to fully address potential confounders, especially indication for use of antidepressants. 8,11 Nevertheless, our findings are similar to those of Einarson and colleagues, who showed that overall antidepressant use during early gestation increased the risk of spontaneous abortion by 63%.…”

Section: 12mentioning

confidence: 99%

See 1 more Smart Citation

Use of antidepressants during pregnancy and the risk of spontaneous abortion

Nakhai-Pour¹,

Broy²,

Bérard³

2010

Canadian Medical Association Journal

136

View full text Add to dashboard Cite

; Centre hospitalier universitaire Sainte-Justine (Nakhai-Pour, Broy, Bérard), University of Montreal, Montréal, Que.; École nationale de la statistique et de l'analyse de l'information (Broy), Rennes, France; and the Ministry of Health and Medical Education (Nakhai-Pour), Tehran, Iran CMAJ 2010. DOI:10.1503/cmaj.091208 Background:The risk of relapse of depression or the diagnosis of some other psychiatric disorders during pregnancy necessitates the use of antidepressants despite possible adverse effects. Whether such use increases the risk of spontaneous abortion is still being debated. We evaluated the risk of spontaneous abortion in relation to the use of antidepressants during pregnancy. Methods:Using a nested case-control study design, we obtained data from the Quebec Pregnancy Registry for 5124 women who had a clinically detected spontaneous abortion. For each case, we randomly selected 10 controls from the remaining women in the registry who were matched by the case's index date (date of spontaneous abortion) and gestational age at the time of spontaneous abortion. Use of antidepressants was defined by filled prescriptions and was compared with nonuse. We also studied the classes, types and doses of antidepressants.Results: A total of 284 (5.5%) of the women who had a spontaneous abortion had at least one prescription for an anti depressant filled during the pregnancy, as compared with 1401 (2.7%) of the matched controls (odds ratio [OR] 2.09, 95% confidence interval [CI] 1.83-2.38). After adjustment for potential confounders, we found that the use of antidepressants during pregnancy was associated with an increased risk of spontaneous abortion (OR 1.68, 95%CI 1.38-2.06). Stratified analyses showed that use of selective serotonin reuptake inhibitors alone (OR 1.61, 95% CI 1.28-2.04), serotonin-norepinephrine reuptake inhibitors alone (OR 2.11, 95% CI 1.34-3.30) and combined use of antidepressants from different classes (OR 3.51, were associated with an increased risk of spontaneous abortion. When we looked at antidepressant use by type versus no use, paroxetine use alone (OR 1.75, 95% CI 1.31-2.34) and venlafaxine use alone (OR 2.11, 95% CI 1.34-3.30) were associated with an increased risk of spontaneous abortion. Interpretation:The use of antidepressants, especially paroxetine, venlafaxine or the combined use of different classes of antidepressants, during pregnancy was associated with an increased risk of spontaneous abortion. Abstract

show abstract

Section: 12mentioning

confidence: 99%

“…Two recent reviews of the association between exposure to antidepressants during early pregnancy and the risk of spontaneous abortion reported contradictory findings. 11,12 We investigated the risk of spontaneous abortion associated with different classes, types and doses of anti depressants during pregnancy, adjusting for indication for use.…”

mentioning

confidence: 99%

Use of antidepressants during pregnancy and the risk of spontaneous abortion

Nakhai-Pour¹,

Broy²,

Bérard³

2010

Canadian Medical Association Journal

136

View full text Add to dashboard Cite

show abstract

“…The effects of the drug are of concern as most of the ADs have the ability to cross the placental barrier in varying and unpredictable quantities (Hostetter et al, 2000;Dalmizrak et al, 2012). There are some clinical studies reporting maternal/neonatal toxicity and withdrawal symptoms attributed to maternal VEN exposures (Broy and Berard, 2010;Nakhai-Pour et al, 2010;Oberlander et al, 2004;Laine et al, 2003;De Moor et al, 2003;Einarson et al, 2001), but these reports are sketchy and inconclusive in nature and the safety of in-utero exposure to VEN especially in terms of fetal/neonatal neurotoxic and neurodegenerative potential has not been established so far. There are evidences that several teratogens (drugs and/or environmental factors) affect the embryo-fetal development by increasing its free radical load and oxidative stress by producing excessive reactive oxygen species (ROS) due to bioactivation (Ornoy, 2007).…”

Section: Introductionmentioning

confidence: 99%

Assessment of in‐utero venlafaxine induced, ROS‐mediated, apoptotic neurodegeneration in fetal neocortex and neurobehavioral sequelae in rat offspring

Singh

Shukla

et al. 2014

Intl J of Devlp Neuroscience

View full text Add to dashboard Cite

Venlafaxine (VEN), a serotonin and noradrenaline reuptake inhibitor is being used as a drug of choice for treating clinical depression even during pregnancy. It is an important therapeutic option in the treatment of perinatal depression, but the effects of VEN on fetus and the newborn are uncertain. Therefore, present study was undertaken to investigate the safety of in-utero exposure to VEN in terms of developmental neurotoxicity and neurodegenerative potential by using prenatal rat model. The selected doses of VEN (25, 40 and 50mg/kg) were administered to pregnant rats from GD 5 to 19 through oral gavage. The fetal brains were dissected and processed for histopathological measurements of neocortical thickness that showed significant reduction. Considering vulnerability of immature brain to free radical injury, VEN exposed neocortices were tested for reactive oxygen species (ROS) levels which were significantly increased. As ROS play important role in the initiation of apoptotic mechanisms, we explored for in situ detection of apoptosis by confocal microscopy that showed enhanced apoptosis including chromatin condensation which was further reconfirmed by electron microscopy. Substantially increased levels of pro-apoptotic protein Bax and decreased levels of anti-apoptotic protein Bcl2 as shown by western blotting also supported the increased neuro-apoptotic degeneration. For further correlation of these findings, prenatally VEN exposed young-adult rat offspring were assessed for open field exploratory behavior that showed increased anxiety-like and stereotypic responses indicating disturbed neurobehavioral pattern. The study concludes that prenatal VEN exposure may primarily enhance ROS generation that plays a key role in regulating release of proapoptotic factors from mitochondria and thereby enhancing apoptotic neurodegeneration that affect proliferation, migration and differentiation of cells, resulting in neuronal deficits manifested as long term neurobehavioral impairments.

show abstract

“…33 Broy and Bérard demonstrated a significant association between the use of the antidepressants paroxetine and venlafaxine and spontaneous abortions. 34 However, the risk-benefit debate for a fetus exposed to SSRIs is still ongoing and, as such, it is not entirely clear whether or not mothers who use SSRIs during pregnancy for depression/stress may also adversely affect the neurological development of their fetuses. 35 One might consider that the pathology related to the serotonin functional polymorphism is not only related to the central neurological/neurotransmitter effect but rather consider ancillary peripheral functions of serotonin based on its placental and myometrial expression.…”

Section: Discussionmentioning

confidence: 99%

Polymorphic variants of the serotonin receptor, 5-HT1A, and the serotonin transporter, 5-HTTLPR, and adverse pregnancy outcomes: A pilot study

Taube

Tevet

Altarescu

et al. 2015

Journal of Reproductive Health and Medicine

View full text Add to dashboard Cite

Gestational Exposure to Antidepressants and the Risk of Spontaneous Abortion: A Review

Abstract: This review suggests that gestational exposure to antidepressants, especially paroxetine and venlafaxine, can lead to spontaneous abortion.

Cited by 27 publications

References 58 publications

Use of antidepressants during pregnancy and the risk of spontaneous abortion

Use of antidepressants during pregnancy and the risk of spontaneous abortion

Assessment of in‐utero venlafaxine induced, ROS‐mediated, apoptotic neurodegeneration in fetal neocortex and neurobehavioral sequelae in rat offspring

Polymorphic variants of the serotonin receptor, 5-HT1A, and the serotonin transporter, 5-HTTLPR, and adverse pregnancy outcomes: A pilot study

Contact Info

Product

Resources

About