Zoloft (sertraline) is one of the most commonly prescribed antidepressants during pregnancy, and it’s generally considered one of the safer SSRIs for use in pregnant patients—especially when treatment is necessary for moderate to severe depression or anxiety.
Safety Overview
FDA Classification
• Previously labeled as Pregnancy Category C, meaning animal studies showed some risk, but human studies are either lacking or inconclusive. (Note: the FDA no longer uses letter categories but instead encourages individualized risk-benefit analysis.)
Potential Risks
• First trimester: Some studies have suggested a slightly increased risk of certain birth defects (e.g., cardiac), but large-scale studies have not consistently confirmed this.
• Third trimester: Like other SSRIs, Zoloft can be associated with neonatal adaptation syndrome, including:
• Irritability
• Respiratory distress
• Jitteriness or tremors
• Feeding issues
These are usually mild and self-limiting.
• There is a slight increased risk of persistent pulmonary hypertension of the newborn (PPHN), but the absolute risk remains low.
Breastfeeding
• Zoloft is often the preferred SSRI for breastfeeding mothers due to its low concentration in breast milk and minimal reported adverse effects in infants.
Clinical Practice
• For many clinicians, Zoloft is the first-line SSRI during pregnancy when pharmacologic treatment is needed.
• The risks of untreated maternal depression/anxiety (e.g., poor prenatal care, increased substance use, suicidal ideation, adverse fetal outcomes) often outweigh the relatively low risks of taking Zoloft.
Summary
• Yes, Zoloft is generally considered safe for pregnant patients, especially when the benefits of treatment outweigh the risks.
• Always a case-by-case decision, best made in consultation with a psychiatrist and OB/GYN.
Would you like a visual comparison chart of SSRIs and their relative safety in pregnancy?
