Pregnancy Outcomes Following Use of Escitalopram: A Prospective Comparative Cohort Study

Abstract

Escitalopram is a serotonin reuptake inhibitor prescribed for depression and anxiety. There is a paucity of information regarding safety in pregnancy. The objective of this study was to determine whether escitalopram is associated with an increased risk for major malformations or other adverse outcomes following use in pregnancy. The authors analyzed pregnancy outcomes in women exposed to escitalopram (n = 212) versus other antidepressants (n = 212) versus nonteratogenic exposures (n = 212) and compared the outcomes. Among the escitalopram exposures were 172 (81%) live births, 32 (15%) spontaneous abortions, 6 (2.8%) therapeutic abortions, 3 stillbirths (1.7%), and 3 major malformations (1.7%). The only significant differences among groups was the rate of low birth weight (<2500 g) and overall mean birth weight (P = .225). However, spontaneous abortion rates were higher in both antidepressant groups (15% and 16%) compared with controls (8.5%; P = .066). There were lower rates of live births (P = .006), lower overall birth weight (P < .001), and increased rates of low birth weight (<2500 g; P = .009) with escitalopram. Spontaneous abortion rates were nearly double in both antidepressant groups (15% and 16%) compared with controls (8.5%) but not significant (P = .066). Escitalopram does not appear to be associated with an increased risk for major malformations but appears to increase the risk for low birth weight, which was correlated with the increase in infants weighing <2500 g. In addition, the higher rates of spontaneous abortions in both antidepressant groups confirmed previous findings.

Selective serotonin reuptake inhibitor antidepressant use in first trimester pregnancy and risk of specific congenital anomalies: a European register-based study

“…Thereafter, starting with paroxetine [22], the SSRIs have come under scrutiny particularly in relation to congenital heart defects (CHD) [22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37]. Although not all studies have supported this association [38][39][40][41][42][43][44][45], meta-analyses have found positive overall evidence [46][47][48][49][50]. Some non-CHD congenital anomalies have also been linked to SSRI exposure in first trimester pregnancy [24,29,32,[34][35] although this literature is much smaller.…”

Effect of antidepressants use in pregnancy on foetus development and adverse effects in newborns

“…In other studies, escitalopram was found to be linked with lower birth weight, but no such association was demonstrated for birth defects [23]. Individual cases of arhinia [24] and necrotising enterocolitis [25] were described in the newborns exposed to prenatal escitalopram.…”

Pharmacotherapy of obsessive-compulsive disorder during pregnancy: a clinical approach

“…30,36,37 Fluvoxamine has the least available data on safety during pregnancy, probably because it is less frequently used by pregnant women compared to other SSRIs. 20,21 Some evidence regarding elevated risk for cardiovascular defects is available for clomipramine, a potent serotonergic tricyclic antidepressant (TCA).…”

“…91 Several studies have suggested an approximately 2-fold increased risk of cardiovascular defects associated with clomipramine, although these studies have some methodological limitations. [31][32][33][34][35][36][37][38][39][40] Although this is a discouraging factor in the use of this drug, the absolute risk of cardiovascular defects is still low. In addition, clomipramine is related to higher risk of PNAS compared to other TCAs.…”