Category: Obstetrics & Gynecology
Keywords: miscarriage, antidepressants (PubMed Search)
Posted: 11/10/2025 by Jennifer Wang, MD
(Updated: 12/5/2025)
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TLDR: Being on antidepressants (specifically SSRIs and SNRIs) does not increase the risk of miscarriage in the first trimester if started before pregnancy, while starting them during pregnancy might present a small increase in risk of miscarriage in that first trimester.
Researchers in the UK looked at patient data from 1996-2018, with almost a million pregnancies evaluated, to look for an association between antidepressant use and first trimester miscarriage, because studies in the past have been iffy about this whole thing. They looked at exposed patients, who were split into two categories: prevalent (started antidepressants at least 3 months prior to pregnancy) and incident (started antidepressants during pregnancy), and nonexposed patients.
The data was analyzed raw and then also after taking out what they felt like would be important confounders (including hx of miscarriage, smoking hx, antipsychotic/seizure medication use, age). Data analyzed after the confounders were taken out of the equation showed that there was no statistical difference in first trimester seizures among patients who were not exposed to SNRIs/SSRIs and prevalent users (or patients who started before pregnancy).
Among incident users, there was a small increase in risk, though the researchers noted that they were concerned about “reserve causation” or patients being started on antidepressants after they had had a miscarriage, which could have screwed with these numbers. The absolute increase in risk was 0.5% (13.1% in non-exposed, and 13.6% in exposed).
Takeaways: Given that we cannot ethically do RCTs on our pregnant patients, this is probably one of the largest population studies to date looking at this issue, and it provides reassuring data. For our patients who are on SSRIs/SNRIs before they get pregnant, you can reassure them that there is good data saying that they are not putting the fetus at increased risk of miscarriage in that first trimester. For patients who need to start on SSRIs/SNRIs during pregnancy, counsel closely, but let them know that our data shows a relatively small absolute risk increase for first trimester miscarriage.
Martin FZ, Madley-Dowd PC, Ahlqvist VH, et al. First trimester antidepressant use and miscarriage: a comprehensive analysis in the Clinical Practice Research Datalink GOLD. Br J Gen Pract. Published online August 7, 2025. doi:10.3399/BJGP.2025.0092
