Is Wellbutrin (bupropion) safe during pregnancy?

From the Guidelines

Wellbutrin (bupropion) can be considered for use during pregnancy, but the decision should be made with a healthcare provider, weighing the potential benefits against the risks, as the most recent and highest quality study suggests that pharmacotherapy for attention-deficit/hyperactivity disorder, including bupropion, has reassuring safety data 1. When considering the use of Wellbutrin during pregnancy, it's essential to evaluate the potential risks and benefits. Some studies suggest that there may be a small increased risk of heart defects in babies exposed to the medication during early pregnancy. However, it's crucial to note that untreated depression or attention-deficit/hyperactivity disorder during pregnancy also carries significant risks for both mother and baby, including poor prenatal care, inadequate nutrition, increased substance use, and complications during delivery. The American Journal of Obstetrics and Gynecology study from 2024 1 provides guidance on managing attention-deficit/hyperactivity disorder in the perinatal period, including the use of pharmacotherapy. The study recommends individualized treatment planning, providing psychoeducation, self-management strategies, or coaching, and psychotherapies, and considering pharmacotherapy for those with moderate or severe attention-deficit/hyperactivity disorder. Other studies, such as the 2019 study published in the Journal of Child Psychology and Psychiatry and Allied Disciplines 1, suggest that maternal antidepressant use during pregnancy does not substantially increase the risk for neurodevelopmental problems, such as autism spectrum disorder and attention-deficit/hyperactivity disorder. However, these studies also emphasize the importance of considering the potential risks and benefits of antidepressant use during pregnancy and providing services to women with depressive and anxiety disorders and their children to reduce the risk of offspring neurodevelopmental problems. Key points to consider when evaluating the use of Wellbutrin during pregnancy include:

• The potential benefits of treating depression or attention-deficit/hyperactivity disorder during pregnancy
• The potential risks of untreated depression or attention-deficit/hyperactivity disorder during pregnancy
• The potential risks of Wellbutrin use during pregnancy, including the possible small increased risk of heart defects
• The importance of individualized treatment planning and collaboration with a healthcare provider to weigh the risks and benefits
• The availability of other treatment options, such as psychotherapy or other antidepressants, and their potential risks and benefits.

From the FDA Drug Label

Talk to your healthcare provider about the risk to your unborn baby if you take bupropion hydrochloride extended-release tablets (XL) during pregnancy. o Tell your healthcare provider if you become pregnant or think you are pregnant during treatment with bupropion hydrochloride extended-release tablets (XL) o If you become pregnant during treatment with bupropion hydrochloride extended-release tablets (XL), talk to your healthcare provider about registering with the National Pregnancy Registry for Antidepressants.

The use of bupropion during pregnancy should be discussed with a healthcare provider to assess the potential risks to the unborn baby. Patients should notify their healthcare provider if they become pregnant or intend to become pregnant during therapy with bupropion hydrochloride extended-release tablets (XL) 2.

From the Research

Wellbutrin Use During Pregnancy

• Wellbutrin, also known as bupropion, is an antidepressant medication that may be used during pregnancy in certain cases 3, 4, 5.
• Studies have shown that bupropion does not increase the risk of major malformations above baseline 4.
• However, one study found a small elevation in the risk of cardiovascular defects associated with bupropion use in the first trimester, although the absolute risk was low 5.
• Another study found that bupropion use during pregnancy was associated with a higher rate of spontaneous abortions, but this rate was still within the general population range 4.

Comparison to Other Antidepressants

• Bupropion has been compared to other antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), in terms of safety during pregnancy 3, 6.
• SSRIs are generally considered to be safe during pregnancy, but may be associated with adverse effects on neonatal adaptation and long-term neurocognitive development 3.
• 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 5.

Clinical Decision-Making

• The decision to use bupropion or any other antidepressant during pregnancy should be made on a case-by-case basis, taking into account the individual patient's needs and medical history 7, 3, 6.
• Clinicians should carefully evaluate the risks and benefits of treatment with bupropion or other antidepressants during pregnancy, and discuss these risks and benefits with their patients 7, 3, 6.