New Zealand’s Medicines and Medical Devices Safety Authority (MEDSAFE) has published few takeaways pertaining to the new minimal risk of postpartum haemorrhage with the consumption of certain anti-depressants for would-be mothers.  

The key takeaways from this are:

• When selective serotonin reuptake inhibitors (SSRIs) and serotonin-noradrenaline reuptake inhibitors (SNRIs) are used during the month leading up to delivery, observational studies have demonstrated a slight increased risk of postpartum haemorrhage.
• With this new mild risk of postpartum bleeding, healthcare providers should continue to evaluate the benefits of treating depression for the mother.

MARC’s Evaluation

In March 2021, during their 185^th meeting, the Medicines Adverse Reactions Committee (MARC) evaluated the risk of postpartum haemorrhage with the usage of SSRIs (citalopram, escitalopram, fluoxetine, sertraline and paroxetine) and SNRIs (venlafaxine) during the month just prior to delivery.

As serotonin affects platelet function, the MARC concluded that a higher risk of postpartum haemorrhage was biologically feasible.

Deeper inspections suggest that a minimal amount of risk (lesser than even a two-fold increase) is possible with the use of SSRIs and SNRIs during the last trimester. The application of vortioxetine, which is a newer anti-depressant too shows similar risk.

The rise in absolute risk of postpartum haemorrhage is still small. Studies have made it clear that if 80 to 100 pregnant women are consuming this anti-depressant just a month before their pregnancy, there might be only a single rise in the number of postpartum haemorrhage cases.

Review and Updates

A systematic review published in 2015 found that none of the research included in the review had information on the exact volume of blood loss or the clinical and therapeutic effects of the blood loss (such as transfusion and prolonged hospital stay).

As per these details that are available healthcare professionals are being constantly reminded to continue to evaluate and re-evaluate the benefits of treating depression for the mother with this new, minimal risk of postpartum bleeding.