title: Selective serotonin reuptake inhibitor use during pregnancy increases the risk of postpartum hemorrhage and anemia: a hospital-based cohort study.
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.
  
  
  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).
  
  
  CONCLUSIONS
  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.affiliation: Division of Obstetrics and Gynecology, Department of Clinical Science, Intervention and Technology (Clintec), Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden.
authors.forename: P G
authors.initials: PG
authors.lastname: Lindqvist
authors.forename: J
authors.initials: J
authors.lastname: Nasiell
authors.forename: L L
authors.initials: LL
authors.lastname: Gustafsson
authors.forename: L
authors.initials: L
authors.lastname: Nordstrom
mesh_terms: D000293:Adolescent; D000328:Adult; D000740:Anemia / Q000209:etiology*; D001792:Blood Platelets / Q000166:cytology; D015992:Body Mass Index; D015331:Cohort Studies; D036861:Delivery, Obstetric; D003863:Depression / Q000150:complications / Q000188:drug therapy*; D057286:Electronic Health Records; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D006760:Hospitalization; D006801:Humans; D015999:Multivariate Analysis; D006473:Postpartum Hemorrhage / Q000209:etiology*; D011247:Pregnancy; D011248:Pregnancy Complications; D011249:Pregnancy Complications, Cardiovascular; D012307:Risk Factors; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects*; D055815:Young Adult
chemical_list: D017367:Selective Serotonin Reuptake Inhibitors
keywords: depression; electronic health record; hemorrhage; obstetric delivery; platelet; selective serotonin reuptake inhibitors