Many women have symptoms of depression before, during and after pregnancy, and selective serotonin reuptake inhibitors (SSRIs) such as citalopram (Celexa® ), fluoxetine (Prozac® ) and sertraline (Lustral®) are often used to help treat these.
They can be used at any stage of pregnancy if clinically indicated, and should not be withheld on the basis of pregnancy.
Any medication taken during pregnancy can potentially have effects on the baby – in this leaflet we will discuss the potential effect of SSRIs, and how we will help care for your baby.
As a mother, one of the most important things for your baby’s health and wellbeing is that you are healthy and in the best possible state of mind. We would not recommend that you stop taking antidepressant medication during or after pregnancy, unless advised otherwise by your doctor or midwife.
Will there be any effect on my baby during pregnancy?
SSRIs are the class of antidepressants for which there is the most fetal safety data and are generally recommended first-line for treatment initiated in pregnancy if clinically appropriate.
There are a number of studies examining several thousand infants, suggesting that there is no increased risk of birth defects or malformations.
Will there be any effect on my baby after birth?
One study reported a slightly increased risk of a rare disorder called Persistent Pulmonary Hypertension of the Newborn (PPHN), a condition where blood flow through the heart is slow to adapt after birth. However, the risk still remains low at approximately 0.4% comparing to 0.1 to 0.2% in the background population.
Some babies may experience some form of ‘withdrawal’ symptoms from SSRIs. These symptoms may include irritability, poor feeding, jitteriness/shaking and breathlessness. Symptoms can present at any time over the first week of life, but usually resolve within a few days and do not require any medical intervention.
Studies suggest an increased risk of fetal heart defects, but there is evidence that the underlying maternal condition may contribute to this finding. The risk is maximum of 3 in every 100 exposed versus approximately 2 in every 100 in the background population. 97 in every 100 women taking an SSRI are expected to have a baby with a normal heart.
There is a very low risk of increased bleeding after giving birth (postpartum haemorrhage) due to effects on platelet aggregation, but it might be significant if you have a risk factor of postpartum haemorrhage such as bleeding disorders.
Can I still breastfeed?
Your breast milk is the best source of nutrition for your baby. There are lifelong benefits for your baby and for you if you breastfeed. Most medications taken by mothers will pass into their breast milk in small quantities. For antidepressants, including SSRIs, the amounts that pass into the milk are very small, and there is no evidence that this has any effect on the baby.
We recommended that being on antidepressant medication should not affect your choice to breastfeed. Staff will help you to feel confident in feeding your baby whichever mode of feeding you choose.
With all SSRIs, your baby should be monitored for drowsiness, poor feeding, adequate weight gain, gastro-intestinal disturbances, irritability, and restlessness.
What will happen to my baby after birth?
- As with all babies, your baby will have a full physical examination, carried out by a Paediatrician/Advanced Neonatal Nurse Practitioner (ANNP)/Midwife
- Your midwife and other staff on the postnatal ward will support you in feeding your baby, and make sure that your baby is feeding well before you go home
- The midwives and doctors looking after your baby will be aware of the possible effects of antidepressants, and will discuss any concerns with you
- Provided you and your baby are well, you will not normally need to stay in hospital for any longer because of antidepressant use in pregnancy
- If you have any concerns that your baby may be struggling to feed, or showing any other symptoms, you can discuss this with your midwife or health visitor at any time
What if I am taking other medications?
This leaflet is written for women taking SSRI antidepressants in pregnancy. If you are taking other antidepressants, or any other medications, please discuss this with your midwife or doctor who will be able to give further advice.
Further Information
If you would like to discuss the contents of this leaflet, or have questions not answered here, please speak to your midwife or General Practitioner (GP), or one of the paediatricians on the postnatal ward.