Miscarriage and preterm birth

Although some data suggest a link between all antidepressants and miscarriage and preterm birth, this association is inconsistent and subject to confounding. SSRIs and SNRIs are the antidepressants most frequently studied in pregnancy; a small but consistent association has seen between:

• paroxetine and venlafaxine and a higher risk of miscarriage,
• SSRI and SNRI use in late pregnancy and a higher risk of preterm birth.

In patients who have risk factors for hypertension or postpartum haemorrhage, or have a history of miscarriages or preterm birth of unknown aetiology, use an antidepressant with extra caution. If an antidepressant is required, it is suggested, on limited evidence, to avoid paroxetine and venlafaxine.

Abruptly stopping clomipramine during pregnancy has been associated with premature birth and neonatal seizures.

Consider the above advice in accordance with Principles of psychotropic use during pregnancy and Considerations for antidepressant use in pregnancy.