From the Guidelines
Bupropion use during pregnancy should be approached with caution and individualized based on the patient's specific situation, with consideration of the potential benefits and risks, as suggested by the American Psychiatric Association and the American College of Obstetricians and Gynecologists 1. When making decisions about bupropion use during pregnancy, it is essential to consider the severity of current symptoms, previous mental health history, and patient treatment preferences, as recommended by Yonkers et al. 1.
Key Considerations
- The potential risks of bupropion use during pregnancy, including a possible small increased risk of cardiac malformations, must be weighed against the risks of untreated depression, which can include poor prenatal care, inadequate nutrition, increased substance use, preterm birth, and postpartum depression.
- Women with moderate to severe depression or those who have had a good response to bupropion previously may benefit from continued use during pregnancy, as the benefits may outweigh the risks, as suggested by DeRubeis et al. 1.
- The immediate-release formulation of bupropion at the lowest effective dose (typically starting at 100 mg twice daily, with a maximum of 450 mg/day) is preferred if bupropion is deemed necessary, with close monitoring throughout pregnancy, as recommended by Stewart 1.
Monitoring and Treatment
- Regular assessment of maternal mental health and fetal development is crucial when bupropion is used during pregnancy.
- The medication should be continued postpartum if needed, with awareness that bupropion passes into breast milk in small amounts, as noted by Gibbons et al. 1.
- A stepped approach to treatment of depression during pregnancy, as recommended by Stewart 1, should be considered, with women with mild depression being monitored and encouraged to exercise and seek social support, and women with moderate-to-severe depression seeking evidence-based treatment.
Patient-Centered Care
- The decision to use bupropion during pregnancy should be made jointly between the patient and healthcare providers, taking into account the individual's unique situation and preferences, as emphasized by Sujan et al. 1.
- Women and their doctors should work together to consider the severity of current symptoms, previous mental health history, and patient treatment preferences when making decisions about antidepressant use during pregnancy, as recommended by Yonkers et al. 1.
From the FDA Drug Label
Data from epidemiological studies of pregnant women exposed to bupropion in the first trimester have not identified an increased risk of congenital malformations overall The estimated background risk for major birth defects and miscarriage are unknown for the indicated population. All pregnancies have a background rate of birth defect, loss, or other adverse outcomes. In the U. S. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2% to 4% and 15% to 20%, respectively Consider the risks to the mother of untreated depression and potential effects on the fetus when discontinuing or changing treatment with antidepressant medications during pregnancy and postpartum
The use of bupropion during pregnancy should be approached with caution. While epidemiological studies have not identified an increased risk of congenital malformations overall, the background risk of major birth defects and miscarriage is still present.
- Key considerations:
- Risks to the mother associated with untreated depression
- Potential effects on the fetus when discontinuing or changing treatment with antidepressant medications during pregnancy and postpartum
- Recommendations:
- Healthcare providers should register patients by calling the National Pregnancy Registry for Antidepressants at 1-844-405-6185 or visiting online at https://womensmentalhealth.org/clinical-and-research-programs/pregnancyregistry/antidepressants/ 2
- Weigh the risks and benefits of bupropion use during pregnancy, taking into account the individual patient's circumstances and medical history 2
From the Research
Bupropion Use During Pregnancy
- Bupropion is used for the treatment of depression and as a smoking cessation aid during pregnancy 3, 4, 5, 6, 7.
- Studies have shown that bupropion does not increase the risk of major malformations above baseline 3.
- However, bupropion use during pregnancy has been linked to a higher risk of spontaneous abortions 3, 6.
- A systematic review of 8 studies found that bupropion use in the first trimester may be associated with a small elevation in the risk of cardiovascular defects, although the absolute risk is low 6.
Safety and Efficacy
- A randomized, placebo-controlled trial found that bupropion sustained release reduced cigarette cravings and total nicotine withdrawal symptoms during the treatment period, but did not increase 7-day point prevalence abstinence rates at the end of medication treatment or at the end of pregnancy 4.
- Another study found that bupropion was not efficacious in promoting smoking cessation at the end of treatment or at week 24, and did not increase the likelihood of smoking cessation in pregnant women 5.
- Bupropion and its major metabolites cross the placenta to the fetal circulation, with higher concentrations of hydroxybupropion and threohydrobupropion in umbilical cord venous plasma than bupropion 7.
Recommendations
- Bupropion may be a reasonable treatment option for depressed pregnant women who require pharmacotherapy, particularly when they also are attempting to reduce nicotine use during pregnancy 6.
- However, the use of bupropion during pregnancy should be carefully considered and monitored due to the potential risks and lack of efficacy in promoting smoking cessation 3, 4, 5, 6, 7.
- More studies are needed to fully understand the safety and efficacy of bupropion use during pregnancy 4, 5, 6.