What are the effects of Escitalopram (Lexapro) during pregnancy?

From the Guidelines

Lexapro (escitalopram) can be used during pregnancy when the benefits outweigh the risks, but should be discussed with a healthcare provider, as recent evidence suggests it does not substantially increase the risk for neurodevelopmental problems such as ASD and ADHD 1. When considering the use of Lexapro during pregnancy, it's essential to weigh the potential benefits against the risks. The medication is generally considered one of the safer antidepressants for pregnant women, with typical dosing ranging from 10-20mg daily.

• Women already on Lexapro who become pregnant shouldn't stop abruptly as untreated depression poses risks to both mother and baby.
• Some studies suggest a small increased risk of persistent pulmonary hypertension in newborns when SSRIs like Lexapro are used in late pregnancy, and mild, temporary withdrawal symptoms may occur in newborns, as noted in a study published in Pediatrics 1.
• The medication works by increasing serotonin levels in the brain to help manage depression and anxiety.
• Regular prenatal care is essential, and any dose adjustments should only be made under medical supervision.
• Alternative treatments like therapy may be considered alongside or instead of medication depending on symptom severity.
• A stepped approach to treatment of depression during pregnancy is recommended, which includes monitoring, exercise, social support, and evidence-based treatment such as cognitive therapy or antidepressants 1. The decision to use Lexapro during pregnancy should balance maternal mental health needs against potential fetal risks, and women and their doctors should work together to consider severity of current symptoms, previous mental health history, and patient treatment preferences when making decisions about antidepressant use during pregnancy 1.

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 effects of Escitalopram (Lexapro) during pregnancy include:

• Risks of persistent pulmonary hypertension of the newborn (PPHN)
• Poor neonatal adaptation
• Complications requiring prolonged hospitalization, respiratory support, and tube feeding in neonates exposed to Escitalopram late in the third trimester
• Clinical findings such as respiratory distress, cyanosis, apnea, seizures, temperature instability, feeding difficulty, vomiting, hypoglycemia, hypotonia, hypertonia, hyperreflexia, tremor, jitteriness, irritability, and constant crying in neonates. 2

From the Research

Effects of Escitalopram on Pregnancy

• The study 3 found that escitalopram exposure during pregnancy 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.
• However, the same study 3 reported that the rate of major malformations is substantially in the range of those reported in unexposed women, suggesting that escitalopram might be considered safe during pregnancy, particularly as far as major malformations are concerned.
• Another study 4 found that selective serotonin reuptake inhibitors, including escitalopram, may be associated with an increased risk of major congenital malformations, congenital heart defects, preterm birth, and neonatal adaptation symptoms.
• A systematic review of meta-analyses 5 suggested a significant positive association between the use of SSRIs, including escitalopram, and the risk of major congenital anomalies, although the data on escitalopram was limited.
• A meta-analysis of cohort studies 6 found that use of SSRIs, including escitalopram, was associated with an increased risk of overall major congenital anomalies and congenital heart defects, although the risk was generally small and argued against a substantial teratogenic effect of SSRIs.

Perinatal Complications

• The study 3 reported that escitalopram exposure during pregnancy was associated with lower rates of live births and higher rates of newborns with low birth weight.
• The study 4 found that SSRIs, including escitalopram, may be associated with an increased risk of preterm birth and neonatal adaptation symptoms.
• The meta-analysis of cohort studies 6 found that sertraline, another SSRI, was associated with septal defects, atrial septal defects, and respiratory system defects, although the evidence for escitalopram was limited.

Breastfeeding

• The study 3 reported that no short-term adverse effects in newborns were reported in the 5 studies evaluating the safety of escitalopram during breastfeeding.
• The study 3 also reported that two infants exposed to escitalopram during lactation did not report any adverse effects at short-term.