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Use of antidepressants near delivery and risk of postpartum hemorrhage: cohort study of low income women in the United States

BMJ 2013; 347 doi: https://doi.org/10.1136/bmj.f4877 (Published 21 August 2013) Cite this as: BMJ 2013;347:f4877

Re: Use of antidepressants near delivery and risk of postpartum hemorrhage: cohort study of low income women in the United States

I am concerned that the obesity data used in this study (a NHANES data set) appears to be non-pregnant data for women of reproductive age. Obesity among women of reproductive age is not the same as obesity at delivery, especially among a depressed cohort. Furthermore, antidepressant medications as well as successful treatment of depression may affect weight gain.

Given that obesity doubles the rate of post partum hemorrhage, controlling for obesity in any study that addresses post partum hemorrhage (PPH) is essential. I am concerned that the external data set introduced an inaccuracy that may have over or underestimated the impact of obesity on PPH among women taking antidepressants at delivery.

More than 50% of pregnant women in America are overweight or obese. To adequately assess the impact of antidepressants on PPH some kind of direct sampling of BMI at delivery was required for a representative sample of the cohort.

Competing interests: No competing interests

27 August 2013
Jen Gunter
Gynecologist
Kaiser Permanente
San Francisco, CA