Is Sertraline (Zoloft) safe during labor?

From the Guidelines

Sertraline is generally considered safe to continue during labor. Women who have been taking sertraline for depression or anxiety during pregnancy should maintain their medication regimen through labor and delivery. Abruptly stopping sertraline could lead to withdrawal symptoms or a recurrence of mental health symptoms at a particularly vulnerable time. The risks of untreated maternal depression or anxiety typically outweigh the minimal risks associated with sertraline exposure during labor. Sertraline (typically dosed at 50-200 mg daily) has a well-established safety profile in pregnancy and labor, with minimal transfer across the placenta, as noted in a study published in Pediatrics 1. Some newborns may experience temporary mild symptoms after birth such as jitteriness or irritability, but these are usually self-limiting and don't require specific treatment. Healthcare providers should be informed about sertraline use so they can monitor both mother and baby appropriately during and after delivery. The mother's mental health stability during this critical time is important for both her wellbeing and early bonding with the newborn.

Key points to consider:

• The benefits of continuing sertraline during labor often outweigh the risks, especially considering the potential for withdrawal symptoms or worsening mental health if the medication is stopped 1.
• Sertraline has a relatively low risk of adverse effects on the newborn, with most symptoms being mild and self-limiting 1.
• Monitoring of both the mother and the newborn is crucial during and after delivery to ensure the best possible outcomes for both.
• The decision to continue sertraline during labor should be made on a case-by-case basis, taking into account the individual woman's health status and medical history.

From the FDA Drug Label

The effect of sertraline on labor and delivery in humans is unknown The FDA drug label does not answer the question.

From the Research

Sertraline Safety During Labor

• The safety of sertraline during labor is not directly addressed in the provided studies, but its use during pregnancy and breastfeeding is discussed 2, 3.
• According to a 2018 study, sertraline is considered one of the safest antidepressants during breastfeeding, and women taking sertraline should be advised to breastfeed and continue the medication, starting with low doses and monitoring the newborn for adverse effects 2.
• A 2017 study found that sertraline and citalopram are recommended as first-line treatments for anxiety and depression in pregnant women, as they have a lower risk of negative outcomes compared to other SSRIs 3.
• However, the studies do not provide information on the safety of sertraline during labor specifically, and more research may be needed to determine its safety during this period.

Sertraline Use During Pregnancy

• A 2017 study reviewed the reproductive safety profiles of different SSRIs, including sertraline, and found that sertraline has a relatively low risk of negative outcomes compared to other SSRIs 3.
• The study found that paroxetine and fluoxetine have a stronger association with negative outcomes, such as significant malformations and persistent pulmonary hypertension, while the associations between sertraline and negative outcomes are mixed and generally unsubstantiated 3.
• A 1999 study discussed the use of SSRIs, including sertraline, in the treatment of various disorders, but did not specifically address their use during pregnancy 4.

Breastfeeding and Sertraline

• A 2018 study found that sertraline is one of the safest antidepressants during breastfeeding, and that the concentration of sertraline in breast milk is very low and has not been linked to infant complications 2.
• The study recommended that women taking sertraline should be advised to breastfeed and continue the medication, starting with low doses and monitoring the newborn for adverse effects 2.
• A 2017 study also found that sertraline can be continued during breastfeeding, as the concentration in breast milk is very low and has not been linked to infant complications 3.