SSRI use during pregnancy and risk for postpartum haemorrhage: a national register-based cohort study in Sweden

Abstract

Objective: Evaluate whether selective serotonin reuptake inhibitor (SSRI) use during pregnancy, as well as prior or current untreated psychiatric illness is associated with postpartum haemorrhage (PPH).

Design: National register-based cohort study based on data from the Swedish Pregnancy Register.

Setting: Sweden, nationwide coverage.

Population: A total of 31 159 pregnant women with singleton deliveries after gestational week 22⁺⁰ between January 2013 and July 2017.

Methods: Pregnant women with self-reported SSRI use at any time point during pregnancy were compared with non-SSRI-treated women with prior or current psychiatric illness, as well as wiith healthy women with no psychiatric illness or reporting SSRI use.

Main outcome measures: Postpartum haemorrhage defined as blood loss >1000 ml during the first 2 hours postpartum reported by the delivering midwife or obstetrician.

Results: Postpartum haemorrhage prevalence was 7.0% among healthy women, 7.6% among women with prior or current psychiatric illness and 9.1% among women treated with SSRI. The unadjusted odds for PPH among women with prior or current psychiatric illness and women on SSRI treatment were increased by 9 and 34%, respectively, compared with healthy unmedicated women without a history of psychiatric illness (odds ratio [OR] 1.09, 95% CI 1.04-1.14 and OR 1.34, 95% CI 1.24-1.44, respectively). The estimates remained unchanged after adjustment for several confounders (such as maternal age, body mass index [BMI], parity, prior caesarean section, smoking, occupation and country of birth) and potential covariates (such as delivery mode, polyhydramnion, preterm delivery, labour dystocia and infant birthweight >4000 g).

Conclusions: Higher risk for PPH was observed both among women treated with SSRI during pregnancy and among women with prior or current psychiatric illness.

Tweetable abstract: SSRI use at any point during pregnancy and prior or current history of psychiatric illness was associated with an increased likelihood for PPH.

Keywords: Bleeding; postpartum haemorrhage; psychiatric illness; selective serotonin reuptake inhibitor.