In this episode of The Good GP, Dr Julia Rawlinson speaks with Dr Florence Martin, an epidemiologist specialising in pregnancy pharmacoepidemiology. Dr Martin discusses her recent study examining the relationship between first trimester antidepressant use and miscarriage risk, using UK primary care data from the CPRD GOLD database.
Dr Martin explains the definitions used for trimesters and miscarriage, and highlights the understanding confounding by indication; how underlying depression, rather than the use of antidepressants, may skew observed associations in raw data. After adjusting for confounding factors, her research found only a modest increase in miscarriage risk for women using antidepressants in the first trimester, with the absolute risk rising slightly from 13.1% to 13.6%.
She further outlines the difference in risk between women who were already taking antidepressants when becoming pregnant and those who started during the first trimester. The findings suggest no increased miscarriage risk for continuing users, while those newly starting medication may show a slight increase, potentially due to residual confounding or early pregnancy detection bias.
Dr Martin encourages GPs to communicate absolute risk clearly and to consider each patient’s context when discussing antidepressant use in pregnancy.
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