Does treatment with citalopram or fluoxetine pose any risks during pregnancy?/nClinical Background:

Fråga: Does treatment with citalopram or fluoxetine pose any risks during pregnancy? Clinical Background: A pregnant woman with depression will be treated with either citalopram or fluoxetine in the fourth month of pregnancy.

Sammanfattning: Available data on fluoxetine and citalopram do not provide evidence that these drugs pose an increased risk for teratogenic effects. Perinatal complications have been observed although these may be related to other factors. However, more studies addressing use during the third trimester are needed before SSRIs can generally be considered safe during pregnancy.

Svar: Questions concerning the use of SSRIs including fluoxetine and citalopram during pregnancy have previously been dealt with in Drugline (1-3).

In summary, data so far obtained do not seem to indicate an increased risk for teratogenic effects or neurodevelopmental delays in the children of mothers who were treated with fluoxetine during the first trimester (1, 4).

Fluoxetine use in the third trimester caused a higher rate of perinatal complications, such as premature delivery, admission to special care and lower birth weight (5). On the other hand this study did not correct for the severity of depression among women requiring pharmacotherapy during pregnancy.

In an animal study, prenatal exposure to fluoxetine produced site-specific and age dependent alterations in brain serotonin transporters in rat (6). The clinical importance of these findings is unknown. However children of mothers taking either a TCA or fluoxetine were compared with control children whose mothers had not been exposed to any agent known to affect the fetus adversely. The study revealed no IQ, language, or behavioral disturbances in the fluoxetine-treated group as compared with the TCA treated or control group (4).

A report from the Swedish Medical Birth Registry containing 546 infants whose mothers were reported to use SSRIs during pregnancy has been published recently (8). Three hundred and seventy-five women used citalopram during pregnancy within the follow-up period of study. The frequency of malformed infants, dead infants, major malformations did not differ when compared to normal population. In this study women who used antidepressants had a tendency to deliver pre-term more often than other women. This was seen for both SSRIs and other antidepressants and is possibly due to underlying conditions or other related factors. For example, women using antidepressants smoke more during early pregnancy than other women (7).