From the Guidelines
Escitalopram should only be used during pregnancy when the potential benefits outweigh the risks, and under the guidance of a healthcare provider, due to the potential for neonatal drug withdrawal and other complications. The use of escitalopram, a selective serotonin reuptake inhibitor (SSRI), during pregnancy is a complex issue that requires careful consideration of the potential risks and benefits 1. According to a study published in Pediatrics in 2012 1, SSRIs, including escitalopram, have been linked to a constellation of neonatal signs, such as continuous crying, irritability, jitteriness, and/or restlessness, which can occur in the first week of life.
Key Considerations
- The decision to use escitalopram during pregnancy should be made in consultation with a healthcare provider who can evaluate the individual's specific situation and medical history 1.
- If a woman is already taking escitalopram and becomes pregnant, she should not stop taking it suddenly, as this can cause withdrawal symptoms and potentially worsen her mental health condition 1.
- Untreated depression or anxiety during pregnancy also carries risks for both mother and baby, including poor prenatal care, inadequate nutrition, increased substance use, and complications during delivery 1.
- Healthcare providers may recommend continuing escitalopram if the depression or anxiety is severe, or they might suggest alternative treatments depending on the specific circumstances and stage of pregnancy 1.
Recommendations for Use
- Escitalopram should be used at the lowest effective dose during pregnancy 1.
- Clinicians should be aware that infants are at risk for manifesting clinical signs of drug toxicity or withdrawal over the first week of life and arrange for early follow-up after the initial hospital discharge 1.
- Mothers on treatment with an SSRI who desire to nurse their infant should be counseled about the risks and benefits 1.
From the FDA Drug Label
Taking Escitalopram late in pregnancy may lead to an increased risk of certain problems in your newborn. Talk to your healthcare provider about the benefits and risks of treating depression during pregnancy If you become pregnant while taking Escitalopram tablets, talk to your healthcare provider about registering with the National Pregnancy Registry for Antidepressants. are pregnant or plan to become pregnant
Escitalopram use in pregnancy is associated with potential risks. The drug label advises that taking escitalopram late in pregnancy may lead to an increased risk of certain problems in the newborn. It is recommended to discuss the benefits and risks of treating depression during pregnancy with a healthcare provider. Additionally, pregnant women taking escitalopram are encouraged to register with the National Pregnancy Registry for Antidepressants 2. Caution is advised when using escitalopram during pregnancy.
From the Research
Escitalopram Use During Pregnancy
- Escitalopram is considered one of the most effective selective serotonin reuptake inhibitors (SSRI) for the treatment of major depression disorder 3, 4.
- The safety profile of escitalopram during pregnancy and breastfeeding has been evaluated in several studies, with some indicating that it may be considered safe during pregnancy, particularly as far as major malformations are concerned 5, 3, 4, 6.
- However, exposure to escitalopram seems to be significantly associated with some perinatal complications, such as lower rates of live births and higher rates of newborns with low birth weight 3, 4.
Comparison with Other SSRIs
- Citalopram and sertraline can be used during pregnancy, while some controversy remains over in utero exposure to paroxetine and fluoxetine, which might be associated with an increased risk of fetal cardiovascular malformation 5.
- Less data is available concerning fluvoxamine and escitalopram use, but current data does not indicate a specific risk 5.
- Citalopram has been studied in pregnancy and lactation, with results suggesting uncomplicated pregnancy outcome in mothers using citalopram during pregnancy and minimal exposure of the infants to citalopram during lactation 7.
Breastfeeding Considerations
- No adverse effects have been reported in the few studies evaluating the safety of escitalopram during breastfeeding 3, 4, 6.
- Data from case series suggest that escitalopram exposure during breastfeeding does not seem to be associated with any short-term adverse effects in newborns 3, 6.
- However, given the paucity of the studies published so far, no definitive conclusions can be drawn on the safety profile of escitalopram during breastfeeding 3, 4, 6.