Is Celexa (Citalopram) Safe During Pregnancy?

What does the evidence say about celexa during pregnancy?

1. Studies covering more than 15,000 pregnancies exposed to citalopram or escitalopram have not found an increased chance of major birth defects, and a study looking specifically at miscarriage did not find an increased risk with these medications. 1
2. Citalopram passes into breast milk in small amounts. Case reports have noted occasional infant drowsiness or weight loss, but most studies of breastfed infants have not reported harmful effects. 1
3. When SSRIs are used in the second half of pregnancy, some but not all studies have linked exposure to a higher chance of persistent pulmonary hypertension of the newborn, a serious but uncommon lung condition estimated at under 1 out of every 100 births. Babies exposed late in pregnancy can also have temporary symptoms like irritability, jitteriness, tremors, and increased crying that are usually mild and resolve within a couple of weeks. 2
4. A clinical review of antidepressant safety in pregnancy found that infants exposed to citalopram late in pregnancy had lower Apgar scores on average than unexposed infants, consistent with the newborn adjustment symptoms seen with third-trimester SSRI exposure. Evidence on first-trimester birth defect risk was mixed: one population-based study linked early citalopram use to a higher chance of neural tube defects, while other analyses found no such association. 3
5. As a class, SSRIs (including citalopram) have been linked to a modestly higher rate of preterm birth in a meta-analysis pooling more than 1.2 million pregnancies, with an adjusted odds ratio of 1.24 after accounting for confounders. Citalopram was not analyzed as its own subgroup in that analysis. Studies like this generally cannot fully separate the effect of the medication from the effect of the depression it manages, since unmanaged depression itself is linked to a higher chance of pregnancy complications. 4

Is celexa safe in each trimester?

• First trimester. In the first trimester, the largest available studies, more than 15,000 pregnancies exposed to citalopram or escitalopram, have not found a consistent increase in major birth defects. A smaller number of studies have raised possible signals for specific defects, including one population-based study linking early citalopram use to neural tube defects, but other analyses have not confirmed this finding. Starting or continuing citalopram in early pregnancy is a decision to make with your prescriber, weighing the benefit of stable mood against these uncertain risks.
• Second trimester. By the second trimester, the research focus shifts from birth defects toward pregnancy complications. SSRIs as a class, including citalopram, have been associated with a modestly higher rate of preterm birth and lower birth weight in large meta-analyses, though unmanaged depression itself also raises these risks, which makes the medication's independent contribution hard to isolate. Most people who are stable on citalopram continue it through this stage under their prescriber's guidance.
• Third trimester. In the third trimester, the main consideration is newborn adjustment after birth. Babies exposed to citalopram late in pregnancy can have temporary symptoms such as irritability, jitteriness, tremors, and increased crying, which are usually mild and resolve within a couple of weeks. A rarer but more serious concern, persistent pulmonary hypertension of the newborn, has also been linked to late-pregnancy SSRI exposure in some studies, at an estimated rate under 1 out of every 100 births. Your care team can plan around these possibilities without requiring you to stop citalopram on your own.