From the Guidelines
Lexapro (escitalopram) used during pregnancy for anxiety may cause side effects that should be carefully considered with your healthcare provider, including a small increased risk of persistent pulmonary hypertension of the newborn (PPHN) and potential neonatal adaptation syndrome. The most recent and highest quality study 1 suggests that SSRIs, including Lexapro, may increase the risk of PPHN when used in late pregnancy, with a number needed to harm of 286 to 351. Common side effects of Lexapro include:
- Nausea
- Headache
- Insomnia
- Fatigue
- Dry mouth
- Dizziness
- Sexual dysfunction More concerning for pregnancy specifically are potential risks to the baby, including:
- A small increased risk of PPHN when used in late pregnancy
- Possible neonatal adaptation syndrome (irritability, feeding difficulties, respiratory problems) if taken near delivery
- A slight increase in the risk of birth defects (particularly heart defects) when used in early pregnancy Some studies suggest a small association with preterm birth and lower birth weight. However, untreated anxiety during pregnancy also carries risks for both mother and baby, including complications like preeclampsia, preterm birth, and developmental issues. The decision to use Lexapro during pregnancy involves weighing these potential medication risks against the risks of untreated anxiety. Typical dosing ranges from 10-20mg daily, and the medication should never be stopped abruptly, especially during pregnancy, as suggested by 1. It is essential to consider the potential risks and benefits of Lexapro use during pregnancy and to consult with a healthcare provider to make an informed decision.
From the FDA Drug Label
There are risks of persistent pulmonary hypertension of the newborn (PPHN) (see Data) and poor neonatal adaptation (see Clinical Considerations) with exposure to selective serotonin reuptake inhibitors (SSRIs), including Escitalopram, during pregnancy. Neonates exposed to SSRIs or SNRIs, including Escitalopram, late in third trimester have developed complications requiring prolonged hospitalization, respiratory support, and tube feeding. Such complications can arise immediately upon delivery Reported clinical findings have included respiratory distress, cyanosis, apnea, seizures, temperature instability, feeding difficulty, vomiting, hypoglycemia, hypotonia, hypertonia, hyperreflexia, tremor, jitteriness, irritability, and constant crying.
The side effects of Lexapro (escitalopram) for anxiety during pregnancy include:
- Persistent pulmonary hypertension of the newborn (PPHN)
- Poor neonatal adaptation
- Respiratory distress
- Cyanosis
- Apnea
- Seizures
- Temperature instability
- Feeding difficulty
- Vomiting
- Hypoglycemia
- Hypotonia
- Hypertonia
- Hyperreflexia
- Tremor
- Jitteriness
- Irritability
- Constant crying 2
From the Research
Side Effects of Lexapro (Escitalopram) for Anxiety During Pregnancy
There are no direct research papers provided to assist in answering this question regarding the side effects of Lexapro (escitalopram) for anxiety during pregnancy. However, some studies provide information on the use of antidepressants during pregnancy and their potential effects on the fetus.
Use of Antidepressants During Pregnancy
- The study 3 examined the risk of congenital cardiac malformations associated with first-trimester exposure to paroxetine, another type of antidepressant, and found that high doses (>25 mg/day) may increase the risk of major congenital malformations.
- Another study 4 investigated the risk of neonatal ventricular septal defect associated with first-trimester ondansetron use and found a dose-dependent increased risk.
Anxiety and Depression During Pregnancy
- A study 5 evaluated the efficacy of a cognitive-behavioral group program in reducing anxious and depressive symptoms in pregnant women and found that it may have a positive impact on women with higher depressive symptoms during pregnancy.
- Research 6 examined the course and risk factors of generalized anxiety disorder (GAD) in pregnancy and found that anxiety symptoms were highest in the first trimester and decreased across pregnancy.
- A prospective study 7 investigated changes in prenatal depression and anxiety levels in low-risk pregnancy among Iranian women and found that the level of depression and anxiety increased during pregnancy, particularly in the second trimester.