From the Guidelines
Escitalopram is not absolutely contraindicated in pregnancy, but it should be used with caution and only when the potential benefits outweigh the risks. For pregnant women with moderate to severe depression or anxiety disorders, continuing escitalopram may be appropriate as untreated maternal mental health conditions can pose significant risks to both mother and baby 1. The typical dosing of escitalopram ranges from 10-20 mg daily, and the lowest effective dose should be used.
Some key considerations when using escitalopram in pregnancy include:
- The risk of neonatal signs such as continuous crying, irritability, jitteriness, and/or restlessness; shivering; fever; tremors; hypertonia or rigidity; tachypnea or respiratory distress; feeding difficulty; sleep disturbance; hypoglycemia; and seizures, which can occur in infants exposed to SSRIs in the third trimester 1.
- The potential for a small increased risk of persistent pulmonary hypertension of the newborn (PPHN) associated with SSRI use in late pregnancy.
- The importance of monitoring women taking escitalopram during pregnancy closely by both psychiatric and obstetric providers, with regular assessment of symptoms and consideration of non-pharmacological treatments when possible.
It is essential to weigh individual circumstances and the severity of maternal mental health symptoms when deciding to use escitalopram during pregnancy, and this decision should be made collaboratively between the patient and healthcare providers 1.
From the Research
Escitalopram Use in Pregnancy
- Escitalopram is not strictly contraindicated in pregnancy, but its use should be carefully considered due to potential risks 2, 3, 4, 5, 6.
- Studies have shown that the rate of major malformations associated with escitalopram exposure during early pregnancy is substantially in the range of those reported in unexposed women 2, 3, 5.
- However, escitalopram exposure may be associated with an increased risk of perinatal complications, such as lower rates of live births and higher rates of newborns with low birth weight 2, 3.
- The available data suggest that escitalopram might be considered safe during pregnancy, particularly as far as major malformations are concerned, but more research is needed to fully understand its safety profile 2, 3, 4, 5, 6.
Breastfeeding Considerations
- There is limited data available on the safety of escitalopram during breastfeeding, but no adverse effects have been reported in the few studies that have evaluated its safety in this context 2, 3, 5.
- Two infants exposed to escitalopram during breastfeeding did not show any health problems, suggesting that it may be safe to use during lactation 3, 5.
- However, more research is needed to fully understand the safety of escitalopram during breastfeeding, and caution should be exercised when using it in this context 2, 3, 4, 5, 6.
Clinical Recommendations
- Clinicians should carefully weigh the potential benefits and risks of escitalopram use during pregnancy and breastfeeding, and consider alternative treatment options when possible 4, 6.
- Close monitoring of maternal and neonatal outcomes is recommended when escitalopram is used during pregnancy or breastfeeding 4, 6.
- An integrated clinical approach, including monitoring of drug levels and routine documentation of neonatal health, can help minimize the effects of treatment on the newborn 6.