What are the effects of Pristiq (desvenlafaxine) on pregnancy?

From the Guidelines

Pristiq (desvenlafaxine) should be used during pregnancy only if the potential benefits outweigh the risks, and the decision to use it should be made after careful consideration of the severity of current symptoms, previous mental health history, and patient treatment preferences, as recommended by the American Psychiatric Association and the American College of Obstetricians and Gynecologists 1. When considering the use of Pristiq during pregnancy, it's essential to weigh the potential benefits against the risks. Pristiq is classified as a pregnancy category C medication, meaning animal studies have shown adverse effects on the fetus, but there aren't adequate well-controlled studies in humans. Some key points to consider include:

• The potential for increased risk of complications like persistent pulmonary hypertension in newborns when antidepressants like Pristiq are used late in pregnancy, although the evidence is not conclusive 1.
• The risk of withdrawal symptoms in newborns if the medication is taken near delivery.
• The importance of not abruptly stopping the medication, as this can cause withdrawal symptoms and potentially worsen depression.
• The significant risks associated with untreated depression during pregnancy, including poor prenatal care, substance abuse, and postpartum depression.
• The potential benefits of continuing Pristiq if depression is severe, or switching to an antidepressant with more pregnancy safety data, such as certain SSRIs. It's crucial to consult with a healthcare provider before making any changes to medication during pregnancy. They can help weigh the potential benefits and risks and make an informed decision about the best course of treatment. Recent research suggests that intrauterine antidepressant exposure does not substantially increase the risk for neurodevelopmental problems like ASD and ADHD, and that other risk factors, such as having a mother with an indication for antidepressant treatment, may be largely responsible for the increased occurrence of these conditions 1. Ultimately, the decision to use Pristiq during pregnancy should be made on a case-by-case basis, taking into account the individual's specific circumstances and needs.

From the FDA Drug Label

There are no published studies on desvenlafaxine in pregnant women; however published epidemiologic studies of pregnant women exposed to venlafaxine, the parent compound, have not reported a clear association with adverse developmental outcomes In reproductive developmental studies in rats and rabbits treated with desvenlafaxine succinate, there was no evidence of teratogenicity at a plasma exposure (AUC) that is up to 19-times (rats) and 0. 5-times (rabbits) the exposure at an adult human dose of 100 mg per day. However, fetotoxicity and pup deaths were observed in rats at 4. 5-times the AUC exposure observed with an adult human dose of 100 mg per day.

Pristiq and Pregnancy:

• The FDA drug label does not provide clear evidence of the safety of desvenlafaxine (Pristiq) during pregnancy.
• Key Risks:
  • Untreated depression in pregnancy
  • Exposure to SNRIs and SSRIs, including desvenlafaxine, during pregnancy
  • Preeclampsia and postpartum hemorrhage
  • Neonatal complications requiring prolonged hospitalization, respiratory support, and tube feeding
• Clinical Considerations:
  • Monitor neonates who were exposed to desvenlafaxine in the third trimester of pregnancy for drug discontinuation syndrome.
  • Weigh the benefits and risks of desvenlafaxine use during pregnancy.
  • Consider the potential risks and benefits of treating depression during pregnancy 2, 2.

From the Research

Pristiq and Pregnancy

• There is limited information available on the use of Pristiq (desvenlafaxine) during pregnancy 3, 4.
• Desvenlafaxine is a serotonin-norepinephrine reuptake inhibitor (SNRI) and is the active metabolite of venlafaxine 3.
• While there is no direct evidence on the safety of Pristiq during pregnancy, one study mentions that desvenlafaxine is generally well tolerated in clinical trials, but common adverse events include nausea, suicidal ideation, and changes in blood pressure and weight 3.
• Another study notes that desvenlafaxine may be a valuable treatment option for major depressive disorder, but its use during pregnancy should be carefully considered due to the potential risks and benefits 4.
• It is essential to consult with a healthcare provider to discuss the potential risks and benefits of using Pristiq during pregnancy, as well as alternative treatment options 5, 6.
• The available evidence on SSRIs, a related class of medications, suggests that some SSRIs, such as fluoxetine, have demonstrated safety in pregnancy 5.
• However, the use of any medication during pregnancy should be carefully evaluated, and the decision to use Pristiq or any other medication should be made in consultation with a healthcare provider, taking into account the individual circumstances and potential risks and benefits 7.