The safety of escitalopram during pregnancy andbreastfeeding: a comprehensive review

Aim The main purpose of this study was to investigate the safety profile of escitalopram (ESC) during pregnancy and breastfeeding. Although Selective Serotonin Reuptake Inhibitors, including ESC, are the antidepressants most frequently prescribed during pregnancy and lactation, there is still some concern about their potential risk of inducing major malformations and perinatal complications. Methodology For this study a combination of both secondary (literature review) and primary (case-studies) research was used. First, MEDLINE and PubMed databases were searched for English language articles by using the following keywords: escitalopram, selective serotonin reuptake inhibitors (SSRIs), major malformations (MMs), perinatal complications (PCs), pregnancy, and breastfeeding. We also reported five original cases of pregnant women were treated with ESC during their pregnancy and breastfeeding at the Clinic of Affective Disorders in Pregnancy and Postpartum of the United Hospital of Ancona (DEGRA Center). Results Although some cases of MMs have been reported in the literature after maternal exposure to ESC during early pregnancy, studies evaluating their absolute and/or relative risk did not find any statistically significant increase of such risk. Very few data are published on the occurrence of PC and miscarriage after exposure to ESC. There are, however, some evidences in the studies so far published of lower rates of live births, higher rates of newborns with low birth weight and lower overall birth weight. No short-term adverse effects in newborns were reported in the studies evaluating the safety of ESC during breastfeeding. Data coming from our case-series are consistent with the available literature, as no MMs, PCs, miscarriage or adverse effects have been reported after ESC exposure during pregnancy or breastfeeding. Conclusions Available data seems to support the notion that ESC has a good safety profile during pregnancy and breastfeeding. Nevertheless, given the paucity of the studies so far published no definitive conclusions should be drawn. Therefore, more prospective longitudinal investigations are needed to better establish the safety profile of this effective antidepressant in pregnancy and lactation.