Prenatal SSRI, SNRI exposure linked to elevated risk of PPH

Women with prenatal exposure to selective serotonin and serotonin-norepinephrine reuptake inhibitors (SSRIs and SNRIs) are at increased risk of postpartum haemorrhage (PPH), although residual confounding cannot be ruled out, as reported in a study.

Researchers conducted a secondary analysis of data on 2,213 pregnancies identified from a large electronic medical record-linkage system. Three exposure groups were established, as follows: SSRI/SNRI-exposed pregnancies (SSRI/SNRI users), antidepressant-unexposed pregnancies (nonusers), and SSRI/SNRI exposure in the year prior to (but not during) pregnancy (former users).

The main outcome of PPH was determined using obstetrician chart diagnoses, diagnosis codes, and recorded estimated blood loss. PPH risk was also examined in relation to prenatal bupropion monotherapy.

The study included 837 SSRI/SNRI users, 401 former users, and 786 nonusers, as well as 114 bupropion users, in the analyses. The rate of PPH was 11.6 percent in the overall cohort, 14.7 percent among SSRI/SNRI users, 10.2 percent among former users, and 8.7 percent among nonusers.

Compared with nonusers, SSRI/SNRI users had a significantly higher risk of PPH in unadjusted (odds ratio [OR], 1.82, 95 percent confidence interval [CI], 1.33–2.49), minimally adjusted (aOR, 1.66, 95 percent CI, 1.19–2.31]), and depression-adjusted models (aOR, 1.46, 95 percent CI, 1.02–2.10).

Former users also showed an increased PPH risk compared with nonusers in unadjusted models (OR, 1.54, 95 percent CI, 1.05–2.26) but not in minimally adjusted (aOR, 1.42, 95 percent CI, 0.95–2.11) or depression-adjusted models (aOR, 1.41, 95 percent CI, 0.95–2.10).

PPH risk did not significantly differ between SSRI/SNRI users and former users, between bupropion users and nonusers, and between SSRI/SNRI users and bupropion users.

The findings highlight the importance of adhering to best-practice PPH risk management strategies for patients with depression, especially those who require treatment with antidepressants during pregnancy.