Is trazodone safe during pregnancy?

What does the evidence say about trazodone during pregnancy?

1. Studies covering over 300 first-trimester trazodone pregnancies found no increased chance of birth defects above the background risk, and multiple studies found no increase in miscarriage. 1
2. One study found no greater chance of low birth weight with trazodone but did find a slightly higher chance of preterm delivery, and newborns exposed near delivery can have temporary withdrawal-type symptoms. 1
3. Major congenital anomalies occurred in 0.6 percent of first-trimester trazodone pregnancies versus 2.6 percent in an SSRI comparison group, across 221 trazodone and 869 SSRI pregnancies, with no significant difference in pregnancy loss or small-for-gestational-age rates. 2
4. Major malformations appeared in 2 of 121 live births, or 1.6 percent, among 147 pregnancies exposed to trazodone or nefazodone in the first trimester, which falls inside the 1 to 3 percent background rate. 3
5. Trouble sleeping is one of the listed signs of depression during pregnancy, so insomnia that lasts for weeks is worth raising with your ob-gyn rather than only managing at bedtime. 4

Is trazodone safe in each trimester?

• First trimester. Two separate bodies of work cover early exposure. MotherToBaby cites studies of over 300 first-trimester pregnancies with no rise in birth defects above background, and a European cohort found major anomalies in 0.6 percent of trazodone pregnancies compared with 2.6 percent in an SSRI comparison group.
• Second trimester. Miscarriage rates have not gone up with trazodone across multiple studies. If you have drifted from occasional use to nightly use, that is worth revisiting, since the pattern actually studied is usually a low off-label dose rather than full antidepressant dosing carried for months.
• Third trimester. One study found no greater chance of low birth weight but did find a slightly higher chance of preterm delivery. Babies exposed near delivery can show brief withdrawal-type symptoms. Third-trimester sleep also fails for mechanical reasons, so ask your provider what belongs in your plan beyond medication.