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Risk of Vaginal Bleeding and Postpartum Hemorrhage After Use of Antidepressants in Pregnancy: A Study From the Norwegian Mother and Child Cohort Study

Lupattelli, Angela MscPharm*; Spigset, Olav MD, PhD†‡; Koren, Gideon MD§; Nordeng, Hedvig PhD*∥

Journal of Clinical Psychopharmacology: February 2014 - Volume 34 - Issue 1 - p 143–148
doi: 10.1097/JCP.0000000000000036
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This study aimed to examine obstetric bleeding outcomes after exposure during pregnancy to selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic (TCAs), and other antidepressants (OADs).

The Norwegian Mother and Child Cohort Study and the Medical Birth Registry of Norway constituted the data source for the present study. We included 57,279 pregnant women, of which 1.02% reported use of antidepressants during pregnancy, mostly SSRIs/SNRIs (0.92%). We categorized exposure according to antidepressant use in pregnancy (SSRIs/SNRIs, n = 527; TCAs/OADs, n = 59; nonexposed, nondepressed, n = 55,411) with inclusion of a disease comparison group (nonexposed, depressed, n = 1282). We used logistic regression to estimate adjusted odds ratio (aOR) and 95% confidence interval (CI) for vaginal bleeding outcomes in pregnancy and postpartum hemorrhage.

Compared with nonexposed subjects, first trimester exposure to SSRIs/SNRIs or TCAs/OADs did not confer any increased risk of vaginal bleeding in early pregnancy (aOR, 0.91; 95% CI, 0.72–1.16 and aOR, 0.83; 95% CI, 0.36–1.92, respectively). No increased risk for vaginal bleeding in midpregnancy was observed among users of SSRIs/SNRIs (aOR, 0.81; 95% CI, 0.50–1.31) or TCAs/OADs (aOR, 0.96; 95% CI, 0.26–3.53) in second trimester. Exposure to SSRIs/SNRIs during gestational week 30 to childbirth did not confer any increased risk of postpartum hemorrhage after vaginal (aOR, 0.90; 95% CI, 0.47–1.74) or cesarean (aOR, 1.47; 95% CI, 0.51–4.22) delivery. Women in the disease comparison group presented a significant moderate increased risk of vaginal bleeding in early pregnancy (aOR, 1.22; 95% CI, 1.06–1.39) and midpregnancy (aOR, 1.28; 95% CI, 1.07–1.55) but not postpartum.

Among this Norwegian cohort of pregnant women, use of antidepressants in pregnancy was not associated with any obstetrical bleeding outcome.

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From the *Department of Pharmacy, School of Pharmacy, University of Oslo, Oslo; †Department of Clinical Pharmacology, St Olav’s University Hospital; ‡Department of Laboratory Medicine, Children’s and Women’s Health, Norwegian University of Science and Technology, Trondheim, Norway; §The Motherisk Program, The Hospital for Sick Children, Toronto, Ontario, Canada; and ∥Division of Mental Health, Norwegian Institute of Public Health, Oslo, Norway.

Received October 22, 2012; accepted after revision May 13, 2013.

Reprints: Angela Lupattelli, MscPharm, Department of Pharmacy, School of Pharmacy, University of Oslo, PO Box 1068 Blindern, 0316 Oslo, Norway (e-mail: angela.lupattelli@farmasi.uio.no).

The Norwegian Mother and Child Cohort Study is supported by the Norwegian Ministry of Health and the Ministry of Education and Research, NIH/NIEHS (contract no. N01-ES-75558), NIH/NINDS (Grant 1 UO1 NS 047537-01 and Grant 2 UO1 NS 047537-06A1), and the Norwegian Research Council/FUGE (Grant 151918/S10).

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© 2014 by Lippincott Williams & Wilkins.