Is third trimester serotonin reuptake inhibitor use associated with postpartum hemorrhage?

Abstract

As serotonin reuptake inhibitor (SRI) use may decrease platelet function, previous research has shown a relationship between SRI use and an increased risk for bruising and bleeding. The literature regarding the association between SRI use during pregnancy and increased bleeding at delivery, referred to as postpartum hemorrhage (PPH), is mixed. In secondary analyses from two prospective observational studies of pregnant women with mood disorders, 263 women were exposed to an SRI (n=51) or not (n=212) in the third trimester. To be precise, we used the terminology estimated blood loss (EBL) > 600 cc rather than the term PPH because the current definition of PPH differs. The occurrence of EBL > 600 cc was determined using the Peripartum Events Scale (PES) completed from obstetrical records by a blinded medically trained member of the study team. EBL > 600 cc occurred in 8.7% of women in this cohort. There was no statistically significant difference in the rates of EBL > 600 cc in the 24 hours after delivery in women taking SRIs during the third trimester (9.8%) compared to non-exposed women (8.5%). Utilizing generalizing estimating equations, the odds of EBL > 600 cc in each group were not significantly different (OR 1.17, CI-0.41-3.32, p=0.77). When the SRI group was limited to women with exposure at the time of delivery, the difference in the odds of EBL > 600 cc was unchanged (OR 1.16, CI=0.37-3.64, p=0.79). In population, both third trimester and use at delivery of SRIs during pregnancy was not associated with an increased risk of excessive blood loss.

Patterns of prenatal antidepressant exposure and risk of preeclampsia and postpartum haemorrhage

“…The two studies that have not reported this association have had 18 or fewer exposed cases. 22,23 Our results are in line with previous large studies, each with more than 55 exposed cases, that found antidepressant use late in pregnancy was associated with an increased risk of PPH. 13,14,[16][17][18][19] Related to our finding that higher sustained doses of antidepressants were associated with higher PPH risk, one previous study among low-income women reported a dose response for serotonin reuptake inhibitors (SRI), but not non-SRIs.…”

“…[8][9][10][11][12][13][14][15][16][17][18][19] Other studies,generally those with smaller numbers of exposed cases, conclude no association between antidepressants and preeclampsia and PPH. [20][21][22][23] Recently, studies have used longitudinal cluster analysis to classify medication use during pregnancy instead of a dichotomous "any use" versus "no use" approach. [24][25][26][27][28] These methods classify individuals with similar patterns of use, allowing for comparisons across groups with less within-group heterogeneity in dose and gestational timing of use that may be important for understanding risks for preeclampsia and PPH.…”

Management of Peripartum Depression: Better, Prevent Than Treat!.

“…Another study evaluated association of SSRIs with risk of postpartum hemorrhage and found no association between them (Kim et al 2016). Currently, it is recommended that women should be encouraged to breast feed while being treated with antidepressants (Kim et al 2014).…”

SSRI use during pregnancy and risk for postpartum haemorrhage: a national register‐based cohort study in Sweden

“…16 Some studies have reported a higher risk of postpartum haemorrhage (PPH) among women on SSRIs, especially if used during the third trimester of pregnancy or in imminent proximity to the delivery. 5,10,[17][18][19] Others, however, have failed to confirm such an association, 8,12,20,21 possibly due to the small size of the exposed population and hence low statistical power, 8,21 as well as differences in the definition of the studied outcome. 8,12,20,21 The most accepted biologically plausible mechanism by which use of SSRI influences the risk of bleeding is by haemostasis impairment, through a decrease in platelet aggregation and function.…”