Selective Serotonin Reuptake Inhibitor (SSRI) updated on 07-01-2025

Postpartum hemorrhage

id	Study   Auto Lee (Controls exposed to TCAs), 2025Lee (Controls unexposed, general pop), 2025Jackson, 2024Palmsten, 2020Skalkidou (Controls unexposed, disease free), 2020Skalkidou (Controls unexposed, sick), 2020Hanley, 2016Lupattelli (Controls unexposed, disease free), 2014Lupattelli (Controls unexposed, sick), 2014Palmsten b, 2013Colvin, 2011Salkeld, 2008	Lib. in paper	Exposition period  Auto during pregnancy (anytime or not specified)1st trimester2nd trimester3rd trimester2nd and/or 3rd trimesterthroughout pregnancyearly pregnancydays before deliverylate pregnancypreconception-onlypericonceptionalpreconceptional for kinetic reasonat least 1st trimester3 months (or more) before pregnancy or during pregnancy1st and 2nd trimester3 months or more before pregnancy or1st trimesterPaternal exp. genotoxic window only (0–3 months preconception)Paternal exposure: epigenetic window only (3–xxx months preconception)Paternal exposure: genotoxic/epigenetic window (0–xxx months preconception)Paternal exposure: other window	Study type  All studies Case control excluded Only case control	Control type    Auto unexposed (general population or NOS)unexposed, sickunexposed, disease freeexposed to other treatment, sicknot specifiedsiblingwhatever (meta-analysis)	Tags	OR 95%CI	x1/n1 x0/n0	no cases	no exposed	ROB	Ref.
S18442 R78270	Lee (Controls exposed to TCAs), 2025	Postpartum haemorrhage	during pregnancy (anytime or not specified)	retrospective cohort (claims database)	exposed to other treatment, sick excluded	Adjustment: No Monotherapy: SSRI only	1.63 [1.03;2.57] C excluded (control group)	91/1,465   24/613	115	1,465		ref
S18408 R77692	Lee (Controls unexposed, general pop), 2025	Postpartum haemorrhage	during pregnancy (anytime or not specified)	retrospective cohort (claims database)	unexposed (general population or NOS)	Adjustment: Yes Monotherapy: SSRI only	1.19 [0.95;1.49]	91/1,465   19,755/463,440	19,846	1,465		ref
S17719 R74736	Jackson, 2024	Post-partum hemorrhage (ICD-10 diagnosis code for PPH and a procedure code for blood transfusion)	during pregnancy (anytime or not specified)	retrospective cohort (claims database)	unexposed, disease free	Adjustment: Yes Monotherapy: SSRI only	1.59 [1.24;2.00]	84/2,106   3,047/105,000	3,131	2,106		ref
S7914 R23953	Palmsten, 2020	Postpartum haemorrhage (PPH) within 14 days after delivery	during pregnancy (anytime or not specified)	retrospective cohort (claims database)	unexposed, sick	Adjustment: No Monotherapy: SSRI only Unexposed sick: recent illness/treatment (during or juste before pregnancy or treatment stopped in view of pregnancy)	1.20 [0.96;1.50] C	149/3,636   170/4,949	319	3,636		ref
S7473 R22365	Skalkidou (Controls unexposed, disease free), 2020	Postpartum haemorrhage (blood loss >1000 ml during the first 2 hours postpartum)	during pregnancy (anytime or not specified)	population based cohort retrospective	unexposed, disease free excluded	Adjustment: Yes Monotherapy: no or not specified	1.33 [1.23;1.44] excluded (control group)	781/8,551   18,520/265,080	19,301	8,551		ref
S7829 R23243	Skalkidou (Controls unexposed, sick), 2020	Postpartum haemorrhage (blood loss >1000 ml during the first 2 hours postpartum)	during pregnancy (anytime or not specified)	population based cohort retrospective	unexposed, sick	Adjustment: No Monotherapy: no or not specified Unexposed sick: old history of illness/treatment (> 12 months before pregnancy) or not specified	1.23 [1.13;1.34] C	781/8,551   2,150/28,390	2,931	8,551		ref
S7604 R22715	Hanley, 2016	Postpartum hemorrhage	late pregnancy	retrospective cohort (claims database)	unexposed (general population or NOS)	Adjustment: Yes Monotherapy: SSRI only	1.07 [0.97;1.18]	486/6,637   21,745/310,813	22,231	6,637		ref
S7599 R23916	Lupattelli (Controls unexposed, disease free), 2014	Postpartum hemorrhage (blood loss greater than 500 mL)	late pregnancy	prospective cohort	unexposed, disease free excluded	Adjustment: Yes Monotherapy: SSRI only	0.97 [0.57;1.65] excluded (control group)	18/123   8,009/55,862	8,027	123		ref
S7902 R23925	Lupattelli (Controls unexposed, sick), 2014	Postpartum hemorrhage (blood loss greater than 500 mL)	late pregnancy	prospective cohort	unexposed, sick	Adjustment: No Monotherapy: SSRI only Unexposed sick: recent illness/treatment (during or juste before pregnancy or treatment stopped in view of pregnancy)	0.87 [0.52;1.47] C	18/123   211/1,282	229	123		ref
S7602 R23860	Palmsten b, 2013	Postpartum hemorrhage (ICD-9 code for 666.x)	late pregnancy	retrospective cohort (claims database)	unexposed, sick	Adjustment: Yes Monotherapy: SSRI only Unexposed sick: old history of illness/treatment (> 12 months before pregnancy) or not specified	1.42 [1.27;1.57]	440/11,516   1,896/69,044	2,336	11,516		ref
S493 R15215	Colvin, 2011	Postpartum hemorrhage (>= 500 mls)	during pregnancy (anytime or not specified)	retrospective cohort (claims database)	unexposed (general population or NOS)	Adjustment: No Monotherapy: no or not specified	1.21 [1.09;1.35]	400/3,703   8,462/92,995	8,862	3,703		ref
S7601 R23861	Salkeld, 2008	Postpartum hemorrhage (diagnosis codes 666.10, 666.12, and 666.14 (ICD-9), codes O72002, O72004, O72102, O72104, O72109, O72202, O72204, or O72209 (ICD-10)) after vaginal or cesarean delivery	3rd trimester	nested case control	unexposed (general population or NOS)	Adjustment: Yes Matched Monotherapy: no or not specified	1.30 [0.98;1.72]	59/501   2,401/25,902	2,460	501		ref
					Total	9 studies	1.24 [1.14;1.35]		62,345	38,238
x1: number of endpoints among exposed, n1: number of exposed; x0: number of endpoints among non exposed, n0: number of non exposed; C: calculated odds ratio from numbers of events and effectives

Forest plot

Sensitivity analysis

Publication bias and p-hacking diagnosis

Sub-groups analysis using all included studies

excluded 7599, 7473, 18442

Umbrella review (other published meta-analyses)