Wellbutrin (Bupropion) Safety During Pregnancy
Bupropion can be used during pregnancy with caution, as it does not appear to significantly increase the risk of major congenital malformations, though there may be a small increased risk of specific cardiovascular defects. 1
Safety Profile in Pregnancy
- Bupropion does not seem to be associated with major congenital malformations or other significant adverse obstetrical outcomes, although data are limited 1
- A small absolute increase in risk has been associated with two specific cardiovascular malformations with first-trimester exposure:
- There is a possible increased risk for diaphragmatic hernia (aOR 2.77; 95% CI, 1.34-5.71), though this has a small absolute risk given the rarity of this condition (population prevalence 0.012%-0.031%) 1
- Some studies have not found these cardiovascular associations, suggesting possible confounding by indication 3
Obstetrical Outcomes
- Possible increased risk for spontaneous abortion has been reported 1, 4
- One case report noted poor neonatal adaptation with seizures due to prolonged hypoglycemia as a consequence of severe hyperinsulinism 1
- Long-term outcomes require further research to clarify possible increased risk for ADHD in offspring, though confounding by indication is likely 1
Breastfeeding Considerations
- Bupropion is present in human milk and has been detected in the serum of infants exposed via breastfeeding, though at very low levels (sometimes undetectable) 1
- Limited data (21 cases) show generally no adverse events, but there have been 2 case reports of seizures in breastfed infants 1
- Caution is advised during breastfeeding 1
Pharmacokinetics in Pregnancy
- Research shows no clinically meaningful differences in the disposition of bupropion or its metabolites during pregnancy, indicating that dose adjustment during pregnancy may not be necessary 5
- Placenta provides a partial barrier for bupropion distribution to the fetus, with umbilical cord venous plasma concentrations 30%-60% lower than maternal plasma concentrations 5
FDA Labeling and Precautions
- The FDA label advises discussing the risk to the unborn baby if taking bupropion during pregnancy 6
- Women who become pregnant while taking bupropion should talk to their healthcare provider about registering with the National Pregnancy Registry for Antidepressants 6
Clinical Recommendations
- For women requiring treatment for depression during pregnancy, bupropion may be a reasonable option, particularly for those also attempting to reduce nicotine use 7
- If taking bupropion before pregnancy, engage in a risk-benefit discussion regarding continuing at the current well-tolerated, effective dose or considering intermittent use 1
- Monitor pregnancy carefully, including fetal growth, blood pressure checks, and appropriate weight gain 1
- For breastfeeding mothers on bupropion, monitor infant development carefully and ensure infants are gaining weight appropriately 1
Important Caveats
- Confounding by indication cannot be ruled out in many studies, as the underlying condition (depression or smoking) may contribute to observed risks 1
- The absolute risk of cardiovascular defects, even if increased, remains relatively low 1
- Benefits of treating maternal depression or supporting smoking cessation may outweigh potential risks in many cases 1, 7
Remember that the decision to use bupropion during pregnancy should follow a careful risk-benefit assessment, considering both maternal mental health needs and potential fetal risks.