Pregnancy and Lactation

Given the widespread use of SSRIs and the high prevalence of mood disorders during the childbearing years, it is likely that these agents are being used during pregnancy and breast feeding. Published information about the use and safety of SSRIs in this special population is greatest for fluoxetine. Goldstein et al. (1997) evaluated the outcomes of 796 prospectively identified pregnancies with confirmed first-trimester exposure to fluoxetine. Historical reports of newborn surveys were used for comparison. Abnormalities were observed in 5% of the fluoxetine-exposed newborns, which was consistent with historical controls.

Pregnancy outcomes and follow-up cognitive and behavioral assessments of 135 children exposed in utero to a TCA or fluoxetine (55 infants) were compared with those in a control group of infant-mother pairs (Nulman et al. 1997). The incidence of major malformations and perinatal complications was similar among the three groups. No statistically significant differences in mean global intelligence quotient (IQ) scores or language development were found in the children of mothers who received a TCA or fluoxetine or control mothers. There were also no differences among the groups on several behavioral assessments. The results of children exposed during the first trimester were not different from those of children exposed throughout the pregnancy. Prospectively derived data are not available for paroxetine, sertraline, fluvoxamine, or citalopram.

Fluoxetine is secreted into breast milk (Hendrick et al. 2001). The implications of this minimal exposure are unclear, but one naturalistic study (Taddio et al. 1996) and two case reports (Burch and Wells 1992; Isenberg 1990), with a total of 13 infants, noted no adverse effects in these infants during the short-term study periods. One case report did describe adverse events in a breast-fed infant whose mother was taking fluoxetine (Lester et al. 1993).

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