Is it safe to take Wellbutrin (bupropion) during pregnancy?

From the Guidelines

Taking Wellbutrin (bupropion) during pregnancy can be considered safe when the benefits outweigh the risks, and it is recommended to weigh the potential risks against the benefits of treating depression or ADHD under the guidance of a healthcare provider. The safety of Wellbutrin during pregnancy is not definitively established, but current evidence suggests a relatively low risk of major birth defects compared to some other antidepressants [ 1 ]. Some studies have indicated a possible small increased risk of heart defects, but the overall risk is considered low. The decision to use Wellbutrin during pregnancy involves careful consideration of the potential risks and benefits, as untreated depression or ADHD during pregnancy can also pose significant risks to both mother and baby [ 1 ].

Key Considerations

• The potential risks of Wellbutrin during pregnancy should be weighed against the benefits of treating depression or ADHD.
• Untreated depression or ADHD during pregnancy can pose significant risks to both mother and baby.
• The typical dosing of Wellbutrin during pregnancy, if deemed necessary, would follow standard guidelines (usually 150-300 mg daily), but the doctor may adjust this based on individual needs and response [ 1 ].
• It is essential to consult a healthcare provider immediately if you are currently taking Wellbutrin and discover you are pregnant, rather than stopping the medication abruptly.

Management and Support

• Preconception counseling and appropriate perinatal planning, management, and support can help mitigate the risks associated with ADHD during the perinatal period [ 1 ].
• Providers should work collaboratively with patients and their support networks to balance the risks of perinatal ADHD medication with the risks of inadequately treated ADHD during pregnancy.
• Psychoeducation, self-management strategies, coaching, and psychotherapies can be beneficial for managing ADHD symptoms during the perinatal period [ 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 Data from the international bupropion Pregnancy Registry (675 first trimester exposures) and a retrospective cohort study using the United Healthcare database (1,213 first trimester exposures) did not show an increased risk for malformations overall.

Key Points:

• There is no increased risk of congenital malformations overall with bupropion use in the first trimester.
• The background risk of major birth defects and miscarriage in the general population is 2-4% and 15-20%, respectively.
• Untreated depression can have risks to the mother and fetus, and the decision to use bupropion during pregnancy should consider these risks.

The use of Wellbutrin (bupropion) during pregnancy can be considered, but it is essential to weigh the potential benefits against the risks, including the risk of untreated depression 2.

From the Research

Safety of Wellbutrin During Pregnancy

The safety of taking Wellbutrin (bupropion) during pregnancy is a concern due to potential risks to the fetus.

• Studies have investigated the association between bupropion use during pregnancy and birth outcomes, such as major malformations, miscarriage, and neonatal complications 3, 4.
• A systematic review found that bupropion use in the first trimester may be linked to a small elevation in the risk of cardiovascular defects, although the absolute risk is low 3.
• Another study found no statistically significant differences in major malformations, live births, stillbirths, therapeutic abortions, mean birth weight, and gestational age at birth between women exposed to bupropion and a nonteratogen group 4.
• However, the same study found a higher rate of spontaneous abortions in the bupropion group compared to the nonteratogen group 4.

Comparison with Other Antidepressants

• A study compared the risk of preeclampsia among women taking different types of antidepressants, including bupropion, during pregnancy 5.
• The results showed that serotonin-norepinephrine reuptake inhibitors (SNRIs) and tricyclic antidepressants were associated with a higher risk of preeclampsia than selective serotonin reuptake inhibitors (SSRIs), but bupropion was not found to increase the risk of preeclampsia 5.
• Another study reviewed the safety concerns associated with the use of SSRIs and other serotonergic/noradrenergic antidepressants during pregnancy, but did not specifically focus on bupropion 6.

Treatment of Postpartum Depression

• Bupropion has been studied as a treatment for postpartum depression, with one pilot study finding it to be effective and well-tolerated in a small group of women 7.
• However, this study did not investigate the safety of bupropion during pregnancy, but rather its use after delivery.

Key Findings

• 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 3.
• However, the decision to use bupropion during pregnancy should be made on a case-by-case basis, taking into account the potential risks and benefits, as well as alternative treatment options 3, 4.