(1160) Psychopharmacotherapy Use in Pregnancies Conceived with IVF and Risk of Postpartum Hemorrhage

Friday, January 31, 2025

4:00 PM – 6:00 PM

Submitting Author(s)

Rachel Solmonovich, MD (she/her/hers)

Resident Physician
Northwell
New Hyde Park, New York, United States

Coauthor(s)

Frank I. Jackson, DO (he/him/his)

Maternal Fetal Medicine Fellow
Northwell
New Hyde Park, New York, United States

Presenting Author(s)

Jamie Green, DO

Resident Physician
Northwell
New Hyde Park, New York, United States

Coauthor(s)

BL

Brenda Lin, MD

Resident Physician
Northwell
New Hyde Park, New York, United States
RG

Randi Goldman, MD

Northwell
New Hyde Park, New York, United States
Matthew J. Blitz, MD

Director of Clinical Research, Maternal-Fetal Medicine, Northwell; Program Director, Maternal Fetal Medicine Fellowship, South Shore University Hospital
Northwell
Bay Shore, NY, United States

Objective: To determine differences in the frequency of psychopharmacotherapy (PPT) use during pregnancies conceived with and without in vitro fertilization (IVF). Secondary objectives were to evaluate rates of PPT drug classes among the cohorts and their associations with postpartum hemorrhage (PPH) requiring transfusion of packed red blood cells (pRBC) among IVF pregnancies.

Study Design: Retrospective cohort study of all deliveries that occurred at ≥ 23 weeks gestational age in a New York academic health system from January 2019 to December 2022. Adjusted odds ratios for non-Hispanic White ethnicity, public insurance, and obesity were calculated using a logistic regression in R version 4.3.1.

Results: A total of 3,383 IVF and 104,297 non-IVF pregnancies were included. Patients who conceived via IVF were more likely to self-identify as non-Hispanic white (54.9% vs. 43.1%), be nulliparous (59.0% vs. 48.7%), and have private insurance (92.3% vs. 64.4%), p< 0.001. Prenatal PPT exposure was more common in pregnancies conceived with IVF, 6.4% vs. 3.5%; aOR 1.62 (95% CI, 1.39 - 1.88; Table 1). IVF pregnancies exposed to PPT had nearly double the odds of experiencing a PPH requiring pRBC (aOR 1.90; 95% CI, 1.18-2.95). Selective Serotonin Reuptake Inhibitors (SSRIs) were associated with a two-fold increase in the odds of PPH requiring pRBC, aOR 2.11 (95% CI, 1.10 - 3.51), and benzodiazepines with three-fold increased odds, aOR 3.22 (95% CI, 1.56 - 6.12).

Conclusion: Prenatal PPT use is higher during IVF pregnancies, specifically SSRIs and benzodiazepines. Their use is associated with increased odds of clinically significant postpartum hemorrhage. While these findings suggest potential risks, they should not discourage mental health treatment, as untreated conditions are also associated with adverse outcomes. These results contribute to comprehensive counseling and informed decision-making when selecting PPT class during pregnancy.