Postpartum hemorrhage is a leading cause of maternal morbidity and mortality for people all over the world. While SSRI/SNRI use may modestly increase the risk, many other well-established factors contribute significantly to the likelihood of PPH. Read more about the most recent data that has been released regarding the use of SSRI/SNRI medications and postpartum hemorrhage.
1. Why the Concern?
SSRIs (like sertraline, fluoxetine) and SNRIs (like venlafaxine) are often frontline treatments for anxiety and depression. They can impair platelet function, which may affect how the body controls bleeding. Since around 6–8% of pregnant women use antidepressants, researchers are investigating whether these medications affect postpartum bleeding risk.
2. Study Findings: Slightly Elevated but Not Alarmingly So
A recent analysis using data from the National Pregnancy Registry for Psychiatric Medications (NPRPM) showed:
- 13.1% of participants experienced Postpartum Hemorrhage, which is much higher than the typical 2–4% estimate
- Overall risk increase:
- Unadjusted odds ratio: 1.42 (95% CI: 0.97–2.08)
- Adjusted odds ratio: 1.33 (95% CI: 0.90–1.97)
- By delivery type:
- Vaginal birth: adjusted OR ~1.04 (no significant change)
- Cesarean section: adjusted OR ~2.21 (95% CI: 1.18–4.13) (a signficant change)
While SSRIs/SNRIs appear to heighten the risk, especially after a C‑section, but further research is needed.
3. What It Means for You
- Keep taking your meds if you’re managing depression or anxiety. It is not advised to cold-turkey stop any psychiatric medication, and untreated depression comes with its own dangers!
- Talk to your providers. Address your concerns with your OB and your psych provider.
- Stay vigilant around delivery: For women on SSRIs/SNRIs, particularly those having C‑sections or who have other PPH risk factors, it’s wise to plan for additional bleeding surveillance after birth.
- Dose matters: Higher or continuous doses of SSRIs might increase the risk more than lower doses.
4. Other Things to Consider
- Estimates of PPH vary widely—from 2–4% in general to 13% in this recent research.
- Experts point out that visual assessments of blood loss can be subjective; more accurate measurement tools and robust study designs are still needed to give us the most accurate data.
5. Major Risk Factors for Postpartum Hemorrhage
It is important to keep in mind that even without the use of SSRI/SNRI medication, a person delivering a baby can still have other risk factors that might increase the risk of postpartum hemorrhage.
- Uterine Atony- this happens when the uterus fails to contract effectively after delivery. The risk of uterine atony increases with multiples, a very long, or very short labor, use of magnesium sulfate, polyhydramnios, or macrosomia.
- Trauma to the Birth Canal- lacerations, uterine rupture, uterine inversion, use of forceps or vacuum
- Retained Placental Tissue- if the body is unable to completely expel the placenta or membranes there is a higher risk
- Blood Clotting Disorders- HELLP syndrome, preeclampsia, placental abruption, bleeding disorders like von Willebrand disease, and anticoagulant medications.
- Infection and Inflammation
- Interventions- C-section, induction, episiotomy, use of anesthesia
- Maternal factors- age, weight, anemia, history of bleeding
6. A Note on Correlation vs. Causation
It is important to understand that just because two things occur together doesn’t mean one caused the other and while antidepressant use might be associated with a slightly increased risk of postpartum hemorrhage, this does not mean it CAUSES it either.
For example: If a patient has multiple known risk factors like:
- A cesarean delivery
- A history of postpartum hemorrhage
- An overdistended uterus (e.g., large baby or twins)
- And is taking an SSRI…
…and then experiences a hemorrhage, we cannot automatically conclude it was caused by the antidepressant alone. It’s far more likely that a combination of factors contributed.
Why This Matters
Blaming a subset of medications, especially ones that are so important for managing perinatal mental health, can lead to unnecessary fear or even discontinuation of treatment at a vulnerable time. Untreated depression and anxiety in the postpartum period carry significant risks for both parent and baby.
