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

Grzeskowiak, L. E., McBain, R., Dekker, G. A. and Clifton, V. L. (2016) Antidepressant use in late gestation and risk of postpartum haemorrhage: a retrospective cohort study. British Journal of Obstetrics and Gynaecology, 123 12: 1929-1936. doi:10.1111/1471-0528.13612


Author Grzeskowiak, L. E.
McBain, R.
Dekker, G. A.
Clifton, V. L.
Title Antidepressant use in late gestation and risk of postpartum haemorrhage: a retrospective cohort study
Journal name British Journal of Obstetrics and Gynaecology   Check publisher's open access policy
ISSN 1471-0528
1470-0328
Publication date 2016-11-01
Year available 2015
Sub-type Article (original research)
DOI 10.1111/1471-0528.13612
Open Access Status Not yet assessed
Volume 123
Issue 12
Start page 1929
End page 1936
Total pages 8
Place of publication Chichester, West Sussex, United Kingdom
Publisher Wiley-Blackwell Publishing
Language eng
Formatted 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.
Keyword Antidepressive agents
Postpartum haemorrhage
Pregnancy
Prenatal exposure
Selective serotonin reuptakeinhibitors
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Mater Research Institute-UQ (MRI-UQ)
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Created: Wed, 16 Nov 2016, 23:47:02 EST by Vicki Clifton on behalf of Mater Research Institute-UQ