Antidepressants during pregnancy and postpartum hemorrhage: a systematic review

Eur J Obstet Gynecol Reprod Biol. 2015 Jun;189:38-47. doi: 10.1016/j.ejogrb.2015.03.022. Epub 2015 Mar 30.

Abstract

The use of antidepressants in pregnancy is increasing. Concerns have risen about the use of antidepressants during pregnancy and the risk of postpartum hemorrhage (PPH). The aim of this systematic review is to summarize evidence on the association between use of antidepressants during pregnancy and the risk of PPH. An Embase and Pubmed search was conducted. English and Dutch language studies reporting original data regarding bleeding after delivery associated with exposure to antidepressants during pregnancy were selected. Quality appraisal was conducted using the Newcastle Ottawa Scale (NOS). Out of 81 citations, 4 studies were included. Based on the NOS, 3 were considered of good quality and 1 was considered of satisfactory quality. Two studies reported an increased incidence of PPH in women who used antidepressants during pregnancy. The other two studies identified no overall increased risk of PPH among pregnant women exposed to antidepressants. The existing evidence remains inconclusive whether use of antidepressants during pregnancy is associated with an increased risk of postpartum hemorrhage. If there is such an association the absolute increased risk will be low and the clinical relevance needs to be further examined.

Keywords: Antidepressants; Postpartum hemorrhage; Pregnancy; SSRIs.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Antidepressive Agents / adverse effects*
  • Female
  • Humans
  • Postpartum Hemorrhage / chemically induced
  • Postpartum Hemorrhage / epidemiology*
  • Pregnancy
  • Risk Factors
  • Selective Serotonin Reuptake Inhibitors / adverse effects

Substances

  • Antidepressive Agents
  • Serotonin Uptake Inhibitors