Department of Clinical Psychopharmacology and Neurotoxicology, National Institute of Mental Health and Neurosciences, Bangalore, India.
J Clin Psychiatry. 2022 Apr 4;83(2):22f14455. doi: 10.4088/JCP.22f14455.
Selective serotonin reuptake inhibitors (SSRIs) may predispose to postpartum hemorrhage (PPH) by interfering with platelet-mediated hemostasis and serotonin-mediated myometrial contractility. A meta-analysis of 8 observational studies found that, regardless of drug class, gestational exposure to antidepressants was associated with a small (odds ratio, 1.25) but statistically significantly increased risk of PPH; however, this finding was true only when antidepressant exposure was proximal to the date of delivery. A recent, moderately large, nationally representative, Swedish observational study also found that gestational exposure to SSRIs was associated with a significantly increased risk of PPH; the crude number needed to harm was 48. For reasons related to the methodology employed, it is possible that the risk was underestimated in this study. The findings of the meta-analysis and of the observational study are examined with a view to help readers understand how to critically read and interpret the research literature in the field. A reasonable viewpoint is that the increase in risk of PPH associated with gestational exposure to SSRIs is smaller than the increase in risk associated with obstetric risk factors for PPH; nevertheless, following precautionary measures would be wise. Such measures would include the routine administration of a uterotonic agent immediately after delivery to all women who have received serotonin reuptake inhibitor treatment during the month preceding delivery; the choice of uterotonic agent would depend on local hospital protocols. Women at risk should also be closely monitored for continued blood loss during the first 24 hours after delivery.
选择性 5-羟色胺再摄取抑制剂（SSRIs）可能通过干扰血小板介导的止血和 5-羟色胺介导的子宫收缩来导致产后出血（PPH）。对 8 项观察性研究的荟萃分析发现，无论药物类别如何，妊娠期暴露于抗抑郁药与 PPH 的风险略有增加（比值比，1.25），但具有统计学意义；然而，只有当抗抑郁药暴露接近分娩日期时，这一发现才是正确的。最近，一项规模较大、具有全国代表性的瑞典观察性研究也发现，妊娠期暴露于 SSRIs 与 PPH 的风险显著增加有关；需要伤害的粗人数为 48。由于所采用的方法学原因，这项研究可能低估了风险。对荟萃分析和观察性研究的结果进行了检查，以期帮助读者了解如何批判性地阅读和解释该领域的研究文献。一个合理的观点是，与 SSRIs 妊娠暴露相关的 PPH 风险增加小于与 PPH 产科危险因素相关的风险增加；然而，采取预防措施是明智的。这些措施包括在分娩前一个月接受 5-羟色胺再摄取抑制剂治疗的所有妇女在分娩后立即常规给予子宫收缩剂；子宫收缩剂的选择将取决于当地医院的方案。高危妇女还应密切监测分娩后 24 小时内的持续失血情况。
