Exposure to SSRI during Pregnancy and Postpartum Hemorrhage Risk

Introduction Prevalence rates of pregnant women with depression are 12.7 - 18.4% worldwide and 16% in Italy. SSRIs (Selective Serotonine Reuptake Inhibitors) are the drug of choice due to their reported safety and efficacy. Recent studies have linked the use of SSRI during pregnancy with a higher risk for post partum hemorrhage (PPH) and consequent maternal anemia during puerperium, being serotonin involved in platelet functioning. Our aim was to evaluate the role of SSRI use during pregnancy in the risk of PPH. Methods Our study is a prospective, observational and experimental case-control study. Cases (n. 43) were caucasian women with a diagnosis of depression and/or anxiety, in treatment with SSRI for the whole pregnancy. Controls (n. 86) were caucasian women without a psychiatric diagnosis and not exposed to SSRIs during pregnancy. Exclusion criteria for both groups were other psychotropic drugs, anti-epileptic drugs, drug of abuse or alcohol addiction, maternal or fetal infectious diseases, fetal/neonatal chromosomal genetic abnormalities. We compared the two groups for demographic, anthropometric and socio-economic variables and evaluated for pregnancy and delivery outcomes, with special attention to PPH risk. Results Our population was homogenous for demographic, anthropometric, socio-economic and obstetric variables except for smoking and mean haemoglobin values before delivery. The analysis of maternal outcomes did not show relevant differences in gestational age, pregnancy complications or type of delivery. SSRIs patients had twice the number of delivery complications than controls: 28% versus 15%. In cases all these complications were PPH. Mean blood loss, number and severity of PPH were higher in cases than in controls. These differences were not statistically significant but close to the relevance treshold. Considering ACOG definition of PPH and by stratifying the population according to the type of delivery (vaginal vs casarean sections) we found that cases had relevantly more PPH after vaginal delivery (27.3% vs 7%, p= 0.04). Conclusions We found that women exposed to SSRIs during pregnancy are at increased risk of postpartum hemorrhage after vaginal delivery. Clinicians should be aware of this increased risk of bleeding, both in relation to pregnancy and surgery in general.