From the Guidelines
There is no clear evidence that taking selective serotonin reuptake inhibitors (SSRIs) while breastfeeding leads to bigger babies. SSRIs such as fluoxetine, sertraline, paroxetine, citalopram, and escitalopram pass into breast milk in very small amounts, typically less than 10% of the maternal dose, as noted in a study published in Pediatrics 1. These minimal amounts are generally not associated with significant weight changes in nursing infants.
Key Points to Consider
- For nursing mothers who need antidepressant medication, SSRIs are often considered compatible with breastfeeding by healthcare providers, due to their low transfer into breast milk 1.
- Sertraline and paroxetine are frequently preferred options as they have lower transfer into breast milk, with paroxetine having a uniformly low ratio of infant to maternal plasma concentrations, less than 0.10 1.
- Many factors influence a baby's growth patterns, including genetics, feeding practices, and overall health.
- If you're concerned about medication effects while breastfeeding, discuss this with your healthcare provider who can monitor your baby's growth and development.
Prioritizing Maternal and Infant Health
The benefits of treating maternal depression often outweigh the minimal risks of SSRI exposure through breast milk, as untreated depression can negatively impact both mother and baby 1. Therefore, nursing mothers should not discontinue their SSRI medication without consulting their healthcare provider, as the risks associated with untreated depression can be more significant than the potential effects of SSRIs on infant growth.
From the Research
Effects of SSRIs on Infant Birth Weight
- There is no direct evidence in the provided studies to suggest that nursing mothers taking SSRIs have bigger babies.
- However, the studies do discuss the effects of SSRIs on infants, including the potential for serotonin reuptake inhibitor-related symptoms in up to 30% of exposed infants postnatally 2.
- The milk-to-plasma ratio of SSRIs is also discussed, with higher ratios rarely associated with a clinically significant impact on babies during early phases of breastfeeding 3.
Safety of SSRIs During Breastfeeding
- Some SSRIs, such as sertraline and paroxetine, are considered to have a better neonatal safety profile during breastfeeding compared to other SSRIs 4.
- The American College of Obstetricians and Gynecologists recommends that treatment with all SSRIs during pregnancy be individualized, and paroxetine use among pregnant women or women planning to become pregnant be avoided if possible 5.
- It is essential to closely monitor infants for any adverse events when the mother is taking SSRIs while breastfeeding 3, 4.
Long-term Neurodevelopmental Outcomes
- Limited data are available on the long-term neurodevelopmental outcomes after SSRI exposure during pregnancy and lactation, but currently, cognitive development seems normal, while behavioral abnormalities may be increased 2.
- Few studies have followed up infants breastfed for assessing neurodevelopmental outcomes, highlighting the need for further research in this area 4.