Is Lexapro Safe During Pregnancy?
Lexapro (escitalopram) is one of two antidepressants the American College of Obstetricians and Gynecologists (ACOG) names as a reasonable first-line choice for depression or anxiety during pregnancy when someone has not taken an antidepressant before, alongside sertraline (Zoloft).
The research on escitalopram in pregnancy is generally reassuring but thinner than for sertraline. ACOG’s endorsement is based partly on how well escitalopram works and how well people tolerate it, rather than on evidence that it is safer in pregnancy. For the full picture, see antidepressants during pregnancy.
Lexapro and Birth Defects
About 3 in 100 babies have a birth defect regardless of medication.
- According to MotherToBaby, most studies have not found that escitalopram or citalopram increases the chance of birth defects.
- Some studies have reported possible heart defect links, but MotherToBaby notes most of those studies have flaws that make it hard to know whether the medication or other factors were responsible.
- Escitalopram is the active form of citalopram (Celexa). A few studies found a small increase in birth defects with citalopram, but it is not known whether that applies to escitalopram, which has less study data of its own.
Across SSRIs as a class, the largest studies that account for depression itself or compare siblings have not found a meaningful increase in birth defects.
Other Pregnancy Risks
- Miscarriage: a study of citalopram and escitalopram did not find an increased chance of miscarriage.
- Preterm birth and low birth weight: some studies suggest a higher chance with use throughout pregnancy, but depression itself is also linked to both, making the cause hard to separate.
- PPHN (a rare newborn lung condition): the overall chance with SSRIs is under 1%, and an analysis cited by ACOG ranked escitalopram second-least likely among SSRIs to be associated with it, after sertraline.
- Newborn adaptation symptoms: some babies exposed late in pregnancy have mild symptoms such as jitteriness or feeding problems, which usually go away within a couple of weeks. Some babies may need extra time in the nursery. Stopping before delivery is not recommended.
- Autism and ADHD: most studies have not found an increased chance once other factors are accounted for.
Is Lexapro Category C?
Lexapro was labeled “Pregnancy Category C” before the FDA removed pregnancy letter categories in 2015 for being confusing and overly simplistic. Zoloft, Prozac and Wellbutrin were Category C as well, so the letter never meant Lexapro was riskier or safer than they are.
Should You Keep Taking Lexapro If You Get Pregnant?
- ACOG recommends against stopping mental health medication because of pregnancy alone.
- If escitalopram has worked for you, ACOG says a previously effective medication should generally be the choice.
- Women who stopped antidepressants during pregnancy relapsed far more often (68%) than those who continued (26%) in one well-known study.
- Do not stop suddenly. Abrupt stopping can cause withdrawal symptoms; plan any change with your prescriber.
Lexapro and Breastfeeding
According to the NIH’s LactMed database, escitalopram is not a reason to stop breastfeeding.
- Doses up to 20 mg a day produce low levels in breast milk. Studies estimate the baby receives about 2.6% to 3.9% of the mother’s weight-adjusted dose.
- Escitalopram was undetectable in the blood of breastfed babies tested in one study.
- No developmental harm has been found in children followed for up to 5 years.
- LactMed advises watching the baby for excess drowsiness, restlessness, agitation, poor feeding and poor weight gain, especially in younger, exclusively breastfed babies and when other psychiatric medications are also used.
- Harm is not expected, especially once the baby is older than 2 months. Isolated case reports of problems in newborns exist, but they have not been shown to be caused by the medication.
If escitalopram kept you well during pregnancy, ACOG advises not switching medications after birth, because your baby’s exposure during pregnancy was far greater than through breast milk. You do not need to pump and dump, and routine blood tests for the baby are not recommended without a specific concern.
Does Lexapro Affect Milk Supply?
There is no strong evidence that escitalopram reduces milk supply. SSRIs can occasionally raise prolactin, and one small study found milk came in about 17 hours later on average in women taking these medications, which may not be clinically important. Breastfeeding support can help if feeding is difficult.
Talk to Your Prescriber
Find a perinatal mental health therapist
If you have thoughts of harming yourself, call or text 988, or call or text the National Maternal Mental Health Hotline at 1-833-TLC-MAMA (1-833-852-6262).
Frequently Asked Questions
Is Lexapro safe during pregnancy?
Most studies have not found an increased risk of birth defects, and ACOG names escitalopram as a reasonable first-line choice if you have not taken an antidepressant before. Its pregnancy data are less extensive than sertraline’s.
Is Lexapro or Zoloft better during pregnancy?
ACOG lists both as reasonable first choices. Sertraline is often preferred because it has more safety research. If one has already worked for you, staying on it is usually recommended.
What pregnancy category is Lexapro?
It was formerly Category C. The FDA removed letter categories in 2015.
Can you take Lexapro while breastfeeding?
Yes. LactMed says escitalopram is not a reason to stop breastfeeding. Watch younger babies for unusual sleepiness or poor feeding.
Should I switch from Lexapro to Zoloft for breastfeeding?
Generally no. If escitalopram kept you stable during pregnancy, ACOG advises not changing medications after birth.
