Selective serotonin reuptake inhibitor use during pregnancy increases the risk of postpartum hemorrhage and anemia: a hospital-based cohort study

J Thromb Haemost. 2014 Dec;12(12):1986-92. doi: 10.1111/jth.12757. Epub 2014 Nov 14.


Background: Selective serotonin reuptake inhibitors (SSRIs) are known to increase the risk of gastrointestinal bleeding.

Objective: Study the risk of bleeding-related complications in relation to SSRI in pregnancy.

Patients/methods: This was a hospital-based cohort study. All women who gave birth at Karolinska University Hospital in Stockholm over a 5-year period (2007 to 2011) were included in the study. Those women who the electronic maternal health record indicated were using SSRI (n = 500) were considered exposed, and all other women formed a control population (n = 39,594). The main outcome measures were blood loss, postpartum hemorrhage (PPH), PP anemia and length of hospitalization.

Results: The absolute risk of PPH and PP anemia for the 1.2% exposed to SSRI were 18.0% and 12.8%, respectively. Women with a vaginal non-surgical delivery who reported use of SSRI during pregnancy had approximately a 2-fold increased risk of both PPH (OR, 2.6; 95% CI, 2.0-3.5) and PP anemia (OR, 2.1; 95% CI, 1.5-2.9), as compared with controls. Blood loss and length of hospitalization were significantly higher among women using SSRI than non-users (arithmetic mean 484 mL vs. 398 mL, 3.8 days vs. 2.4 days, respectively).

Conclusion: The use of SSRI during pregnancy increases blood loss and doubles the risk of PPH and PP anemia in a setting where SSRI had not been considered a risk factor for increased blood loss. Because PPH is a leading cause of maternal mortality and morbidity, the awareness of bleeding-related complications is important, both in relation to pregnancy and to surgery in general.

Keywords: depression; electronic health record; hemorrhage; obstetric delivery; platelet; selective serotonin reuptake inhibitors.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Anemia / etiology*
  • Blood Platelets / cytology
  • Body Mass Index
  • Cohort Studies
  • Delivery, Obstetric
  • Depression / complications
  • Depression / drug therapy*
  • Electronic Health Records
  • Female
  • Gastrointestinal Hemorrhage / etiology*
  • Hospitalization
  • Humans
  • Multivariate Analysis
  • Postpartum Hemorrhage / etiology*
  • Pregnancy
  • Pregnancy Complications
  • Pregnancy Complications, Cardiovascular
  • Risk Factors
  • Serotonin Uptake Inhibitors / adverse effects*
  • Young Adult


  • Serotonin Uptake Inhibitors