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

作者：Grzeskowiak L E^*; McBain R; Dekker G A; Clifton V L

来源：BJOG: An International Journal of Obstetrics and Gynaecology , 2016, 123(12): 1929-1936.

DOI：10.1111/1471-0528.13612

• Antidepressive agents
• postpartum haemorrhage
• pregnancy
• prenatal exposure
• selective serotonin reuptake inhibitors

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.

• 出版日期2016-11