Antidepressant use in late gestation and risk of postpartum haemorrhage: a retrospective cohort study

    loading  Checking for direct PDF access through Ovid

Abstract

Objective

To investigate the association between antidepressant use in late gestation and postpartum haemorrhage (PPH).

Design

Retrospective cohort study.

Setting

Tertiary teaching hospital in Adelaide, Australia.

Population

A total of 30 198 women delivering between 2002 and 2008.

Methods

Relative risks adjusted for maternal sociodemographics and comorbidities (aRRs) were calculated for PPH, comparing women with late-gestation exposure to antidepressants (n = 558), women with a psychiatric illness but no antidepressant use (n = 1292), and women with neither antenatal exposures (n = 28 348). Additional sensitivity analyses were undertaken, examining associations with severe PPH and postpartum anaemia.

Main outcome measures

The primary outcome was PPH, defined as a recorded blood loss of ≥500 mL for vaginal deliveries and ≥1000 mL for caesarean sections. Secondary outcomes included severe PPH (≥1000 mL blood loss, irrespective of method of delivery), and the presence of postpartum anaemia (identified from hospital medical records).

Results

Compared with unexposed controls, women exposed to antidepressants had an increased risk of PPH (aRR 1.53; 95% confidence interval, 95% CI 1.25–1.86), whereas no increased risk was observed for women with a psychiatric illness but no antidepressant use (aRR 1.04; 95% CI 0.89–1.23). In sensitivity analyses, late gestation antidepressant exposure was associated with an increased risk of severe PPH (aRR 1.84; 95% CI 1.39–2.44), as well as postpartum anaemia (aRR 1.80; 95% CI 1.46–2.22).

Conclusions

Exposure to antidepressants in late gestation was associated with a significantly increased risk of PPH. Although potential confounding by unmeasured factors cannot be ruled out, these findings suggest a direct effect of antidepressant exposure on PPH.

Tweetable abstract

Late gestation antidepressant exposure is associated with a significantly increased risk of postpartum haemorrhage.

Related Topics

    loading  Loading Related Articles