Heller Hanna M, Ravelli Anita C J, Bruning Andrea H L, de Groot Christianne J M, Scheele Fedde, van Pampus Maria G, Honig Adriaan
Department of Hospital Psychiatry, VU University Medical Centre, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
Department of Medical Informatics, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
BMC Pregnancy Childbirth. 2017 Jun 2;17(1):166. doi: 10.1186/s12884-017-1334-4.
Postpartum haemorrhage is a major obstetric risk worldwide. Therefore risk factors need to be investigated to control for this serious complication. A recent systematic review and meta-analysis revealed that the use of both serotonergic and non-serotonergic antidepressants in pregnancy are associated with a higher risk of postpartum haemorrhage. However, use of antidepressants in pregnancy is often necessary because untreated depression in pregnancy is associated with adverse maternal and neonatal outcome, such as postpartum depression, preterm birth and dysmaturity. Therefore it is of utmost importance to unravel the possible association between postpartum haemorrhage and the use of serotonergic and other psychopharmacological medication during pregnancy.
We performed a matched cohort observational study consecutively including all pregnant women using serotonergic medication (n = 578) or other psychopharmacological medication (n = 50) visiting two teaching hospitals in Amsterdam between 2010 and 2014. The incidence of postpartum haemorrhage in women using serotonergic medication or other psychopharmacological medication was compared with the incidence of postpartum haemorrhage in 641,364 pregnant women not using psychiatric medication selected from the database of the Netherlands Perinatal Registry foundation (Perined). Matching took place 1:5 for nine factors, i.e., parity, maternal age, ethnicity, socioeconomic status, macrosomia, gestational duration, history of postpartum haemorrhage, labour induction and hypertensive disorder.
Postpartum haemorrhage occurred in 9.7% of the women using serotonergic medication. In the matched controls this was 6.6% (p = 0.01). The adjusted odds ratio (aOR) before matching was 1.6 (95% CI 1.2-2.1) and after matching 1.5 (95% CI 1.1-2.1). Among the women using other psychopharmacological medication, the incidence of postpartum haemorrhage before matching was 12.0% versus 6.1% (p = 0.08) with OR 2.1 (95% CI 0.9-4.9), and after matching 12.1% versus 4.4% (p = 0.03) with aOR of 3.3 (95% CI 1.1-9.8).
Pregnant women using serotonergic medication have an increased risk of postpartum haemorrhage, but this high risk is also seen in pregnant women using other psychopharmacological medication. We suggest that this higher risk of postpartum haemorrhage could not only be explained by serotonin, but also by other mechanisms. An additional explanation could be the underlying psychiatric disorder.
产后出血是全球范围内主要的产科风险。因此，需要对风险因素进行调查以控制这一严重并发症。最近的一项系统评价和荟萃分析显示，孕期使用血清素能和非血清素能抗抑郁药均与产后出血风险较高相关。然而，孕期使用抗抑郁药通常是必要的，因为孕期未治疗的抑郁症与不良的母婴结局相关，如产后抑郁、早产和胎儿发育不全。因此，阐明产后出血与孕期使用血清素能及其他精神药物之间可能存在的关联至关重要。
我们进行了一项匹配队列观察性研究，连续纳入2010年至2014年间在阿姆斯特丹两家教学医院就诊的所有使用血清素能药物（n = 578）或其他精神药物（n = 50）的孕妇。将使用血清素能药物或其他精神药物的女性产后出血发生率与从荷兰围产期注册基金会（Perined）数据库中选取的641,364名未使用精神药物的孕妇的产后出血发生率进行比较。针对九个因素进行1:5匹配，即产次、产妇年龄、种族、社会经济状况、巨大儿、孕周、产后出血史、引产和高血压疾病。
使用血清素能药物的女性中有9.7%发生了产后出血。在匹配对照组中，这一比例为6.6%（p = 0.01）。匹配前调整后的优势比（aOR）为1.6（95%CI 1.2 - 2.1），匹配后为1.5（95%CI 1.1 - 2.1）。在使用其他精神药物的女性中，匹配前产后出血发生率为12.0%，而对照组为6.1%（p = 0.08），优势比为2.1（95%CI 0.9 - 4.9），匹配后分别为12.1%和4.4%（p = 0.03），aOR为3.3（95%CI 1.1 - 9.8）。
使用血清素能药物的孕妇产后出血风险增加，但使用其他精神药物的孕妇也存在这种高风险。我们认为，产后出血风险较高不仅可以用血清素解释，还可能由其他机制导致。另一种解释可能是潜在的精神疾病。
