P G Lindqvist1, J Nasiell, L L Gustafsson, L Nordstrom. 1. Division of Obstetrics and Gynecology, Department of Clinical Science, Intervention and Technology (Clintec), Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden.
Abstract
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.
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.
Authors: Deborah R Kim; Emily Pinheiro; James F Luther; Heather F Eng; John L Dills; Stephen R Wisniewski; Katherine L Wisner Journal: J Psychiatr Res Date: 2015-11-19 Impact factor: 4.791
Authors: Hanna M Heller; Anita C J Ravelli; Andrea H L Bruning; Christianne J M de Groot; Fedde Scheele; Maria G van Pampus; Adriaan Honig Journal: BMC Pregnancy Childbirth Date: 2017-06-02 Impact factor: 3.007
Authors: Essi Heinonen; Barbara Szymanska-von Schultz; Viktor Kaldo; Josefine Nasiell; Ewa Andersson; Mikaela Bergmark; Margareta Blomdahl-Wetterholm; Lisa Forsberg; Erik Forsell; Anna Forsgren; Sandra Frööjd; Amy Goldman; Eva-Mari Nordenadler; Myrto Sklivanioti; Mats Blennow; Katarina Wide; Lars L Gustafsson Journal: BMJ Open Date: 2018-08-05 Impact factor: 2.692
Authors: E Heinonen; M Blennow; M Blomdahl-Wetterholm; M Hovstadius; J Nasiell; A Pohanka; L L Gustafsson; K Wide Journal: Eur J Clin Pharmacol Date: 2021-03-22 Impact factor: 2.953