Preliminary Study Links SSRI/SNRI Use to Increased Postpartum Hemorrhage Risk

The study, published in the Journal of Women's Health, suggests that clinicians should view patients exposed to SSRIs and SNRIs as having an elevated risk for postpartum hemorrhage. The researchers stressed the need for additional research to better quantify this heightened risk.

"While these findings are consistent with growing evidence that SSRI/SNRI exposure may slightly increase the risk of postpartum hemorrhage, especially following a C-section, the study lacked sufficient power to draw definitive conclusions," Adele C. Viguera, Cleveland Clinic, Neurological Institute, Cleveland, Ohio, USA, and colleagues wrote.

Previous research indicates a potential link between exposure to selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors during late pregnancy and an elevated risk of postpartum hemorrhage (PPH). The National Pregnancy Registry for Psychiatric Medications has been tracking the outcomes of pregnancies involving psychiatric drug use to better understand the risks and benefits associated with these treatments.

Against the above background, Viguera et al. conducted a first pregnancy registry study to compare PPH outcomes among women with psychiatric illnesses exposed or unexposed to SSRIs/SNRIs proximate to delivery.

To evaluate the relationship between SSRI/SNRI exposure in late pregnancy and PPH risk, the researcher used data from the National Pregnancy Registry for Psychiatric Medications. The study analyzed a sample of 953 participants, utilizing retrospectively gathered medical records on postpartum blood loss. The cohort included 453 individuals who were not exposed to SSRIs/SNRIs during pregnancy and 500 who were exposed at least during the delivery week.

Postpartum hemorrhage was defined as estimated blood loss of 500 mL or more after vaginal delivery or 1,000 mL or more following a cesarean section, with excessive bleeding starting within the first 24 hours postpartum. Univariate and multivariate logistic regression analyses were conducted to calculate odds ratios.

The study led to the following findings:

• PPH incidence was 13.1%.
• SSRI/SNRI exposure was associated with a PPH unadjusted odds ratio of 1.42 compared to no exposure and an adjusted odds ratio of 1.33.
• When stratified by delivery type, the odds ratio following vaginal delivery among women exposed to SSRIs/SNRIs was 1.04 versus 2.31 for C-section delivery; the adjusted C-section odds ratio was 2.21.

"These preliminary data underscore the need for further research involving larger sample sizes. However, they also highlight the importance of enhanced clinical monitoring for postpartum hemorrhage after cesarean sections, particularly for women with other known risk factors who are exposed to SSRIs/SNRIs in late pregnancy," the researchers concluded.

Reference:

Viguera AC, Jones A, Szpunar MJ, Bernstein SN, Killenberg PC, Sojka ET, Rossa ET, Gaccione P, Freeman MP, Cohen LS. The Risk of Postpartum Hemorrhage with Selective Serotonin Reuptake Inhibitors and Serotonin Norepinephrine Reuptake Inhibitors: Preliminary Results from the Massachusetts General Hospital National Pregnancy Registry for Psychiatric Medications. J Womens Health (Larchmt). 2024 Jul 22. doi: 10.1089/jwh.2024.0033. Epub ahead of print. PMID: 39037008.