Bobo William V, Moore Katherine M, Betcher Hannah K, Larish Alyssa M, Stoppel Cynthis M, VandeVoort Jennifer L, Chauhan Mohit, Athreya Arjun P, Talati Ardesheer
Department of Behavioral Science and Social Medicine, Florida State University College of Medicine, Tallahassee, FL, USA.
Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA.
J Child Adolesc Psychopharmacol. 2024 Dec;34(10):428-446. doi: 10.1089/cap.2024.0085. Epub 2024 Oct 25.
Despite advances in obstetric care, postpartum hemorrhage (PPH) is a leading cause of maternal mortality worldwide. Prior reviews of studies published through 2016 suggest an association of antidepressant use during late pregnancy and increased risk of PPH. However, a causal link between prenatal antidepressants and PPH remains controversial. This systematic literature review aimed to synthesize the empirical evidence on the association of antidepressant exposure in late pregnancy with the risk of PPH, including studies published before and after 2016. A systematic literature search was conducted using PubMed, OVID Medline, EMBASE, SCOPUS, PsycINFO, and CINAHL from inception to September 9, 2023. Original, peer-reviewed studies (published in English) that reported on the frequency or risk of PPH in women with evidence of antidepressant use during pregnancy and included at least one control group were included. Twenty studies (eight published after 2016) met inclusion criteria, most of which focused on the risks of PPH associated with selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs). The main findings from the individual studies were mixed, but the majority documented statistically significant associations of PPH with late prenatal exposure, especially for exposures occurring within 30 days of delivery, compared with unexposed deliveries. Fourteen studies addressed underlying antidepressant indications or their correlates. Few studies focused on prenatal antidepressants and the risk of well-defined severe PPH or on antidepressant dose changes and general PPH risk. None examined competing risks of antidepressant discontinuation on mental health outcomes. Late pregnancy exposure to antidepressants may be a minor risk factor for PPH, but it is unclear to what extent reported associations are causal in nature, as opposed to correlational (effects related to nonpharmacological factors including maternal indication). For patients needing antidepressants during pregnancy, current evidence does not favor routinely discontinuing antidepressants specifically to reduce the risk of PPH.
尽管产科护理取得了进展，但产后出血（PPH）仍是全球孕产妇死亡的主要原因。对截至2016年发表的研究的先前综述表明，妊娠晚期使用抗抑郁药与PPH风险增加有关。然而，产前抗抑郁药与PPH之间的因果关系仍存在争议。本系统文献综述旨在综合关于妊娠晚期接触抗抑郁药与PPH风险之间关联的实证证据，包括2016年之前和之后发表的研究。使用PubMed、OVID Medline、EMBASE、SCOPUS、PsycINFO和CINAHL进行了系统的文献检索，检索时间从数据库建立至2023年9月9日。纳入了原始的、经过同行评审的研究（以英文发表），这些研究报告了有孕期使用抗抑郁药证据的女性中PPH的发生频率或风险，并且至少包括一个对照组。二十项研究（八项在2016年之后发表）符合纳入标准，其中大多数关注与选择性5-羟色胺再摄取抑制剂（SSRIs）或5-羟色胺-去甲肾上腺素再摄取抑制剂（SNRIs）相关的PPH风险。个体研究的主要结果不一，但大多数研究记录了PPH与产前晚期接触之间具有统计学意义的关联，特别是与未接触药物的分娩相比，在分娩前30天内发生的接触。十四项研究探讨了潜在的抗抑郁药适应症或其相关因素。很少有研究关注产前抗抑郁药与明确界定的严重PPH风险，或抗抑郁药剂量变化与一般PPH风险。没有研究考察抗抑郁药停药对心理健康结果的竞争风险。妊娠晚期接触抗抑郁药可能是PPH的一个次要风险因素，但尚不清楚所报告的关联在多大程度上是因果关系，而不是相关性（与包括母亲适应症在内的非药理学因素相关的影响）。对于孕期需要抗抑郁药的患者，目前的证据不支持为降低PPH风险而常规停用抗抑郁药。
