Lexapro (escitalopram) is a commonly prescribed SSRI (selective serotonin reuptake inhibitor) used to treat depression and anxiety. Its safety in pregnancy is a nuanced issue and depends on individual circumstances. Here’s a general overview:
FDA Category and General Considerations
• Lexapro was previously classified as Pregnancy Category C, meaning that animal studies have shown some adverse effects on the fetus, but there are no adequate well-controlled studies in humans. The potential benefits may warrant use in pregnant women despite potential risks.
Potential Risks
• First trimester: Some studies have suggested a small increased risk of congenital malformations, especially cardiac defects, though the data is not conclusive.
• Third trimester: Use in late pregnancy may be associated with neonatal adaptation syndrome (irritability, tremor, respiratory distress, etc.), and in rare cases, persistent pulmonary hypertension of the newborn (PPHN).
• There is also a possible link to preterm birth or low birth weight.
Benefits and Risk Balance
• Untreated moderate-to-severe maternal depression/anxiety can pose serious risks to both the mother and fetus, including poor prenatal care, poor nutrition, suicidality, and adverse developmental outcomes.
• For many patients, continuing Lexapro during pregnancy may be safer than discontinuing it, especially if the depression is severe or recurrent.
Clinical Practice
• Many clinicians may continue Lexapro during pregnancy if the patient has had good response and stability on it, especially if alternatives are less effective or unknown for the patient.
• Decisions should be made on a case-by-case basis with a psychiatrist and obstetrician in collaboration.
Would you like a comparison with other antidepressants considered safer in pregnancy, like sertraline or fluoxetine?
