Salkeld Erin, Ferris Lorraine E, Juurlink David N
Department of Public Health Sciences, Faculty of Medicine, University of Toronto, Ontario, Canada.
J Clin Psychopharmacol. 2008 Apr;28(2):230-4. doi: 10.1097/JCP.0b013e318166c52e.
Limited evidence suggests that selective serotonin reuptake inhibitor (SSRI) antidepressants can hinder platelet aggregation and can increase the risk of hemorrhage. Because antenatal depression is common and is often treated with antidepressants, we sought to determine if exposure to SSRI antidepressants in late pregnancy is associated with an increased risk of postpartum hemorrhage compared with non-SSRI antidepressants.
This was a population-based nested case-control study of women aged 16 to 45 years in Ontario, Canada, who received government-funded prescription coverage within 2 years before delivery. We identified case patients with postpartum hemorrhage and matched controls (1:10) without postpartum hemorrhage from the same cohort. Controls were matched to cases on age, mode of delivery, parity, and calendar time. We linked prescription claims data to hospital and physician records for the study period (January 1999 to March 2005). Exclusion criteria included drugs and medical conditions that predispose to hemorrhage, and receipt of multiple antidepressants in the 6 months preceding delivery. Antidepressant drug exposure was classified as SSRI or other agents within 90 days before delivery.
There were 2460 postpartum hemorrhage cases and 23,943 matched controls. The adjusted odds ratio for the association between postpartum hemorrhage and exposure to SSRIs within 90 days before index date was 1.30 (95% confidence interval, 0.98-1.72) as compared with 1.12 (95% confidence interval, 0.62-2.01) for non-SSRIs.
Selective serotonin reuptake inhibitors confer no disproportionate risk of postpartum hemorrhage at the time of delivery compared with non-SSRI antidepressants. This information may help guide decisions regarding pharmacotherapy for depression during pregnancy.
有限的证据表明，选择性5-羟色胺再摄取抑制剂（SSRI）类抗抑郁药会阻碍血小板聚集，并增加出血风险。由于产前抑郁很常见且常需用抗抑郁药治疗，我们试图确定与非SSRI类抗抑郁药相比，妊娠晚期使用SSRI类抗抑郁药是否会增加产后出血风险。
这是一项基于人群的巢式病例对照研究，研究对象为加拿大安大略省16至45岁、在分娩前2年内享受政府资助处方保险的女性。我们确定了产后出血的病例患者，并从同一队列中匹配了无产后出血的对照（1:10）。对照在年龄、分娩方式、产次和日历时间上与病例相匹配。我们将研究期间（1999年1月至2005年3月）的处方索赔数据与医院和医生记录相链接。排除标准包括易导致出血的药物和医疗状况，以及在分娩前6个月内接受多种抗抑郁药治疗的情况。抗抑郁药暴露被分类为分娩前90天内使用的SSRI类药物或其他药物。
共有2460例产后出血病例和23943例匹配对照。与非SSRI类药物相比，指数日期前90天内产后出血与暴露于SSRI类药物之间关联的校正比值比为1.30（95%置信区间为0.98-1.72），而非SSRI类药物为1.12（95%置信区间为0.62-2.01）。
与非SSRI类抗抑郁药相比，选择性5-羟色胺再摄取抑制剂在分娩时不会带来不成比例的产后出血风险。该信息可能有助于指导孕期抑郁症药物治疗的决策。
