From the Guidelines
Wellbutrin (bupropion) can be considered a relatively safe option during pregnancy, particularly for individuals requiring treatment for co-occurring depression, given the available safety data for this drug in the perinatal period. According to a recent study published in the American Journal of Obstetrics and Gynecology in 2024 1, switching from stimulants to bupropion in the perinatal period is a possible solution, especially for individuals with co-occurring depression.
Key Considerations
- The decision to use Wellbutrin during pregnancy should be made in consultation with a healthcare provider, weighing the benefits against the risks.
- Untreated depression during pregnancy poses significant risks to both mother and baby, including poor prenatal care, inadequate nutrition, increased substance use, and potential for self-harm.
- Alternative antidepressants like certain SSRIs (particularly sertraline/Zoloft) have more safety data in pregnancy and are often preferred.
- A study published in the Journal of Child Psychology and Psychiatry and Allied Disciplines in 2019 1 suggests that intrauterine antidepressant exposure does not substantially increase the risk for neurodevelopmental problems like ASD and ADHD.
Recommendations
- Women taking Wellbutrin who become pregnant or are planning pregnancy should discuss this with their doctor immediately to determine the safest approach for their specific situation.
- A stepped approach to treatment of depression during pregnancy, as recommended by experts 1, should be considered, including monitoring, exercise, social support, and evidence-based treatment like cognitive therapy and antidepressants.
- The American Psychiatric Association and the American College of Obstetricians and Gynecologists' recommendations 1 should be taken into account, considering severity of current symptoms, previous mental health history, and patient treatment preferences when making decisions about antidepressant use during pregnancy.
From the FDA Drug Label
Talk to your healthcare provider about the risk to your unborn baby if you take bupropion hydrochloride extended-release tablets (XL) during pregnancy. o Tell your healthcare provider if you become pregnant or think you are pregnant during treatment with bupropion hydrochloride extended-release tablets (XL) o If you become pregnant during treatment with bupropion hydrochloride extended-release tablets (XL), talk to your healthcare provider about registering with the National Pregnancy Registry for Antidepressants.
The FDA drug label does not provide a clear answer to whether Wellbutrin is safe for pregnancy, but it advises patients to talk to their healthcare provider about the risk to their unborn baby if they take bupropion hydrochloride extended-release tablets (XL) during pregnancy 2. It is recommended to register with the National Pregnancy Registry for Antidepressants if pregnancy occurs during treatment 2.
From the Research
Safety of Wellbutrin During Pregnancy
- The safety of Wellbutrin (bupropion) during pregnancy has been evaluated in several studies 3, 4, 5.
- A systematic review of 8 studies found that bupropion use in the first trimester was linked to a small elevation in the risk of cardiovascular defects, although the absolute risk was low 3.
- Another study found that bupropion exposure during the first trimester did not increase the risk of major malformations above baseline, but was associated with a higher rate of spontaneous abortions 4.
- A retrospective case-control study found a positive association between early pregnancy bupropion use and left outflow tract heart defects, although the magnitude of the observed increased risk was small 5.
- A meta-review of 51 meta-analyses found that antidepressant drugs, including bupropion, may increase the risk of major congenital malformations, congenital heart defects, and other adverse outcomes, but the evidence was not conclusive for bupropion specifically 6.
Risks and Benefits
- The risks of bupropion use during pregnancy must be weighed against the benefits of treating depression and other conditions 7.
- Untreated depression during pregnancy can have adverse maternal, pregnancy, and infant outcomes, and treatment with bupropion may be a reasonable option for some women 3, 7.
- However, the use of antidepressant drugs during pregnancy should be carefully considered and monitored, and women should be informed of the potential risks and benefits 6, 7.
Clinical Implications
- Clinicians should carefully evaluate the risks and benefits of bupropion use during pregnancy and consider alternative treatments when possible 6, 7.
- Women who are pregnant or planning to become pregnant should be closely monitored for any potential adverse effects of bupropion use 3, 4, 5.
- Further research is needed to fully understand the safety and efficacy of bupropion use during pregnancy 3, 6, 5.