HFSMedical ProvidersMaternal and Child HealthInformation for Providers on Antidepressants During Pregnancy and Breast Feeding - September 2011

Information for Providers on Antidepressants During Pregnancy and Breast Feeding - September 2011

This chart is produced by the University of Illinois at Chicago (UIC) Perinatal Mental Health Project as a summary of research on antidepressants in human pregnancy and breastfeeding.

Sources of data: 

*Specific references are available on request.

General guideline: 

  • Optimal treatment is based on individual patient characteristics and clinical judgment, especially weighing medication risks against risks of untreated illness. Risks of untreated perinatal depression may include preterm birth and other obstetric complications, increased risk of infection and difficult temperament in the infant, impaired parenting, and psychological effects such as impaired cognitive development, emotional and behavioral problems and increased reactivity to stress in children.

Antidepressants as a group may be associated with following risks: 

  • Increased risk of preterm birth and lower gestational age at birth, but without adverse effects on birth weight or Apgar scores

  • Increased risk of miscarriage, but rates within norms of the general population

SSRI antidepressants as a group (citalopram, escitalopram, fluoxetine, paroxetine, sertraline) may be associated with the following risks:  

Information for Providers On Antidepressants During Pregnancy & Breast Feeding - September 2011 

 

Antidepressant

Advantages

During

Pregnancy

Teratogenicity

Other Disadvantages

During

Pregnancy

Estimated %

of

Maternal

Dose to

Breastfeeding

Baby

Reported

Side Effects

to Breastfeeding Babies

Bupropion

  • Fewer sexual side effects

  • Less risk of weight gain

  • Helps with smoking cessation

Morphologic- limited evidence of cardiac malformations; increased risk for pulmonary hypertension

Behavioral- limited evidence of increased risk of ADHD

  • Limited data available

  • Lowers seizure threshold

  • Can cause insomnia

  • May increase risk of miscarriage

2.0%

Seizures

Citalopram

  • Few interactions with other medications

Morphologic- risk of neural tube defect

Behavioral- none found

  • Limited data available

0.7% - 9.0%

Uneasy sleep, drowsiness, irritability, weight loss

Desipramine

  • More studies in human pregnancy, including neurodevelopmental follow-up

Morphologic- none found

Behavioral- none found

1.0%

Agitation of newborn, potential triggering of seizure activity if there is a history of seizures

Duloxetine

  • Also treats diabetic peripheral neuropathic pain

Morphologic- unknown

Behavioral- unknown

  • No systematic studies in human pregnancy

0.1%

Unknown

Escitalopram

  • Few interactions with other medications

Morphologic- unknown

Behavioral- unknown

  • No systematic studies in human pregnancy

3.9% - 7.9%

Enterocolitis

Fluoxetine

  • More studies in human pregnancy, including meta-analysis and neurodevelopmental follow-up

Morphologic- increased risk of cardiovascular malformations*

Behavioral- none found

  • More reports of neonatal side effects than most other antidepressants

1.2% - 12.0%

Excessive crying,

irritability, vomiting, watery stools, difficulty sleeping, tremor, somnolence, hypotonia, decreased weight gain, hyperglycemia

Mirtazapine

Morphologic- none found

Behavioral- unknown

0.6% - 2.8%

None

Nortriptyline

  • More studies in human pregnancy, including neurodevelopmental follow-up

Morphologic- none found

Behavioral- none found

1.3%

None

Paroxetine

  • Minimal association with cardiovascular malformations but may be optimal for some individual parents

Morphologic- possible increased risk of cardiovascular malformations

Behavioral- unknown

  • More reports of neonatal side effects than most other antidepressants ACOG recommends fetal echo for all exposed fetuses

0.1% - 4.3%

Irritability, sleepiness, constipation, SIADH

Sertraline

Morphologic- unlikely increased risk of omphalocele and septal defects*

Behavioral- none found

  • Minimal association with omphalocele and septal defects

0.4% - 2.3%

Drug of choice by OBs & Pediatricians

Venlafaxine

  • None specific, but may be optimal for some individual patients

Morphologic- none found

Behavioral- unknown

  • Limited data available

5.2% - 7.6%

Decreased weight gain

Desvenlafaxine

  • None specific, but may be optimal for some individual patients

Morphologic- unknown

Behavioral- unknown

  • No systematic studies in human pregnancy

Unknown

Unknown

* Findings from one study at variance with other data, perhaps due to methodological flaws 

© 2011 The Board of Trustees of the University of Illinois, UIC Perinatal Mental Health Project. All rights reserved.

 For questions, references, or permission to reprint, call the UIC Perinatal Mental Health Project at 1-800-573-6121

 1. Physician's Desk Reference. Thomson Reuters. Montvale, NJ. 2. Toh et al. Selective serotonin reuptake inhibitor use and risk of gestational hypertension. Am J Psychiatry. 2009 Mar;166(3):320-8. 3. Alwan, S. et al. Use of selective serotonin-reuptake inhibitors in pregnancy and the risk of birth defects. N Engl J Med. 2007 Jun 28; 356(26):2684-92. 4. Wogelius et al. Maternal use of selective serotonin reuptake inhibitors and risk of congenital malformations. Epidemiology. 2006 Nov;17(6):701-4. 5. Suri et al. Effects of Antenatal Depression and Antidepressant treatment on gestationl age at birth and risk of preterm birth. Am J Psychiatry. 2007 Aug; 164:1206-1213. 6. Figueroa. Use of antidepressants during pregnancy and risk of Attention-Deficit/Hyperactivity Disorder in the offspring. JDBP. 2010 Oct. Vol 31, No.8. 7. Alwan et al. Maternal use of Bupropion and risk of congenital heart defects. Am J Obstet Gynecol 2010.


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