Prenatal antidepressant exposure may elevate risk of postpartum haemorrhage

Women with prenatal exposure to selective serotonin and serotonin-norepinephrine reuptake inhibitors (SSRIs and SNRIs) appear to be at increased risk of postpartum haemorrhage (PPH), according to a study.

Researchers conducted a secondary analysis of data from a cohort of 2,213 pregnancies identified from a large electronic medical record-linkage system. Electronic prescriptions records were reviewed to identify exposure to antidepressants during pregnancy, with participants grouped as follows: SSRI/SNRI-exposed pregnancies (SSRI/SNRI users), antidepressant-unexposed pregnancies (nonusers), and SSRI/SNRI exposure in the year prior to pregnancy (former users).

PPH incidence was determined using obstetrician chart diagnoses, diagnosis codes, and recorded estimated blood loss (EBL). Unadjusted, minimally adjusted (maternal age at delivery, delivery year, parity, and maternal smoking), and depression-adjusted models (previous covariates and maternal depression) were applied to evaluate the risk of PPH by exposure group. Supplemental analyses were also conducted to assess PPH risk with prenatal bupropion monotherapy.

The analysis included 837 SSRI/SNRI users, 401 former users, and 786 nonusers, as well as 114 bupropion users identified for additional analyses. PPH occurred in 11.6 percent of participants in the overall cohort, 14.7 percent of SSRI/SNRI users, 10.2 percent of former users, and 8.7 percent of nonusers.

Compared with nonuse, SSRI/SNRI use was associated with a heightened risk of PPH in unadjusted (odds ratio [OR], 1.82, 95 percent confidence interval [CI], 1.33–2.49), minimally adjusted (adjusted OR [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 use was also associated with increased risk of PPH in the unadjusted model (OR, 1.54, 95 percent CI, 1.05–2.26]) but not in the minimally adjusted (aOR, 1.42, 95 percent CI, 0.95–2.11) and depression-adjusted models (aOR, 1.41, 95 percent CI, 0.95–2.10).

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

These findings underscore the need to adhere to best-practice PPH risk management strategies for depressed patients, especially those who require treatment with antidepressants during pregnancy, the researchers said.