- Maternal use of the selective serotonin and norepinephrine reuptake inhibitor duloxetine during pregnancy is tied to increased risk for postpartum hemorrhage and cardiac malformations.
Why this matters
- Authors say that these “relatively uncommon” outcomes should be considered against the benefits of treating depression and other targeted symptoms during pregnancy.
- Various subcohorts consisted of 1.3-4.1 million women.
- Exposures during pregnancy varied from about 2500-3000 for exposures during early pregnancy to 900-950 for later pregnancy exposures.
- Baseline risk for cardiovascular malformations was 13.7 per 1000 unexposed women (95% CI, 13.5-13.9).
- Baseline risk for postpartum hemorrhage was 23.3 per 1000 unexposed women (95% CI, 23.1-23.4).
- Adjusted relative risk for cardiovascular malformations in exposed group was 1.29 (95% CI, 0.99-1.68).
- This risk was not significantly different from that among women exposed to selective serotonin reuptake inhibitors.
- Adjusted relative risk for postpartum hemorrhage was 1.53 (95% CI, 1.08-2.18).
- Women with duloxetine exposure tended to be older and white, have more chronic conditions, use other drugs more frequently, and seek health care more.
- Cohort study; 8,410,882 women in the United States with public insurance and their liveborn infants.
- Subcohort sizes varied by target outcome.
- Funding: Eli Lilly and Company.
- Exposure windows could have been misclassified if date of last menstrual period was miscalculated.