{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,28]],"date-time":"2025-09-28T00:07:24Z","timestamp":1759018044360,"version":"3.44.0"},"reference-count":52,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2025,8,9]],"date-time":"2025-08-09T00:00:00Z","timestamp":1754697600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Human Psychopharmacology"],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>Prior studies have raised concerns about postpartum hemorrhage (PPH) risk associated with selective serotonin and serotonin\u2010norepinephrine reuptake inhibitors (SSRIs and SNRIs), although limitations include possible confounding by maternal indications. The current study examined the risk of PPH associated with prenatal S\/NRIs accounting for diagnosed maternal depression during pregnancy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The current study is a secondary analysis of data from a cohort of 2213 pregnancies (1997\u20132010) identified from a large electronic medical record\u2010linkage system. Exposures were identified from electronic prescriptions records and resulted in three main groups: S\/NRI\u2010exposed pregnancies (S\/NRI users), antidepressant\u2010unexposed pregnancies (non\u2010users), and S\/NRI exposure in the year prior to (but not during) pregnancy (former users). Data used to identify PPH occurrences included obstetrician chart diagnoses, diagnosis codes, and recorded estimated blood loss (EBL). The risk of PPH by exposure group was estimated using unadjusted, minimally adjusted (maternal age at delivery, delivery year, parity, and maternal smoking), and depression\u2010adjusted models (previous covariates and maternal depression). Supplemental analyses included an examination of PPH risk with prenatal bupropion monotherapy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The study cohort consisted of 837 S\/NRI users, 401 former users, and 786 non\u2010users, as well as 114 bupropion users identified for additional analyses. The frequency of PPH was 11.6% in the overall cohort, and was 14.7% for S\/NRI users, 10.2% for former users, and 8.7% for non\u2010users. The risk of PPH was significantly higher for S\/NRI users than non\u2010users in unadjusted (OR 1.82 [95% CI 1.33, 2.49]), minimally adjusted (aOR 1.66 [1.19, 2.31]), and depression\u2010adjusted models (aOR 1.46 [1.02, 2.10]). The risk of PPH was also higher for S\/NRI former users than non\u2010users in unadjusted models (OR 1.54 [1.05, 2.26]) but not minimally adjusted (aOR 1.42 [0.95, 2.11]) or depression\u2010adjusted models (aOR 1.41 [0.95, 2.10]). No significant differences in PPH risk were observed between S\/NRI users and former users, between bupropion users and non\u2010users, or between S\/NRI users and bupropion users.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Prenatal S\/NRI exposure was associated with an increased risk of PPH after adjusting for maternal depression, although residual confounding and confounding by other factors (including unmeasured factors) may be possible, as the risk of PPH appeared to be similar between S\/NRI users and former users. Best\u2010practice PPH risk management strategies should be adhered to for depressed patients, especially those who require treatment with antidepressants during pregnancy.<\/jats:p><\/jats:sec>","DOI":"10.1002\/hup.70015","type":"journal-article","created":{"date-parts":[[2025,8,9]],"date-time":"2025-08-09T15:39:13Z","timestamp":1754753953000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Maternal Use of Antidepressants in Pregnancy and the Risk of Postpartum Hemorrhage: An Electronic Health Record\u2010Based Cohort Study"],"prefix":"10.1002","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5674-3079","authenticated-orcid":false,"given":"William V.","family":"Bobo","sequence":"first","affiliation":[{"name":"Department of Psychiatry &amp; Psychology Mayo Clinic Florida  Jacksonville Florida USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Launia","family":"White","sequence":"additional","affiliation":[{"name":"Department of Quantitative Health Sciences Mayo Clinic  Jacksonville Florida USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Hodge","sequence":"additional","affiliation":[{"name":"Department of Quantitative Health Sciences Mayo Clinic  Jacksonville Florida USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katherine","family":"Moore","sequence":"additional","affiliation":[{"name":"Department of Psychiatry &amp; Psychology Mayo Clinic  Rochester Minnesota USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hannah","family":"Betcher","sequence":"additional","affiliation":[{"name":"Department of Psychiatry &amp; Psychology Mayo Clinic  Rochester Minnesota USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alyssa M.","family":"Larish","sequence":"additional","affiliation":[{"name":"Department of Obstetrics &amp; Gynecology Mayo Clinic  Rochester Minnesota USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cynthia","family":"Stoppel","sequence":"additional","affiliation":[{"name":"Department of Psychiatry &amp; Psychology Mayo Clinic  Rochester Minnesota USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ardesheer","family":"Talati","sequence":"additional","affiliation":[{"name":"Department of Psychiatry Columbia University Irving Medical Center  New York New York USA"},{"name":"New York State Psychiatric Institute  New York New York USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,8,9]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpsychires.2021.01.036"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000005202"},{"volume-title":"Advanced Trauma Life Support (Student Manual)","year":"1997","author":"American College of Surgeons","key":"e_1_2_8_4_1"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamapsychiatry.2020.2453"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.psc.2016.04.010"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.2147\/ndt.s54710"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1089\/cap.2024.0085"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1136\/amiajnl\u20102014\u2010002699"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2015.03.022"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0893\u2010133x(01)00298\u20106"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.2147\/ndt.s279342"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000002351"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/aog.0000000000004972"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.2165\/00003495\u2010200868050\u201000011"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2023.18212"},{"issue":"1","key":"e_1_2_8_17_1","first-page":"2","article-title":"Mechanism of Antidepressant Activity of Bupropion","volume":"11","author":"Ferris R. 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