Association between psychopharmacotherapy and postpartum hemorrhage
Frank I Jackson1,2,3, Insaf Kouba1,2,3, Natalie Meirowitz1,3,4
1Northwell, New Hyde Park, NY (Jackson, Kouba, Meirowitz, Keller, Bracero, and Blitz).
AJOG Global Reports
|November 8, 2024
Summary
Prenatal psychopharmacotherapy (PPT) use is linked to a higher risk of postpartum hemorrhage (PPH) requiring transfusion. Combination PPT therapy showed a greater association with PPH than monotherapy.
Area of Science:
- Obstetrics and Gynecology
- Perinatal Mental Health
- Pharmacology
Background:
- Inconsistent findings exist regarding the link between psychopharmacotherapy (PPT) and postpartum hemorrhage (PPH).
- Clarifying this relationship is crucial for patient counseling and risk assessment.
- This study investigates the association between prenatal PPT exposure and PPH requiring transfusion.
Purpose of the Study:
- To evaluate the association between prenatal PPT exposure and PPH requiring packed red blood cell transfusion (PPH+pRBC).
- To examine the link between individual PPT drug classes and PPH+pRBC.
- To assess the association between mental health treatment intensity and PPH+pRBC.
Main Methods:
- Retrospective cross-sectional study of 107,425 deliveries between January 2019 and December 2022.
- Analysis of prenatal exposure to various psychotropic medications, including SSRIs, SNRIs, benzodiazepines, and others.
- Multivariable logistic regression adjusted for known hemorrhage risk factors.
Main Results:
- Prenatal PPT exposure occurred in 3.6% of pregnancies, with a PPH+pRBC rate of 5.5% compared to 2.8% in unexposed pregnancies (aOR 2.10).
- SSRIs and benzodiazepine monotherapy were associated with increased PPH+pRBC odds.
- Combination PPT was linked to significantly higher odds of PPH+pRBC (aOR 3.96) compared to monotherapy and no PPT use.
Conclusions:
- Prenatal psychopharmacotherapy exposure is associated with increased odds of clinically significant postpartum hemorrhage requiring transfusion.
- Combination therapy demonstrated a stronger association with PPH+pRBC compared to monotherapy.
- These findings underscore the importance of careful risk-benefit assessment for pregnant individuals using psychotropic medications.
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