Pregnancy & Medications - MGH Center for Women's Mental Health

What Would You Do? A Pregnant Women on Duloxetine (Cymbalta)

Ms. A is a 27-year-old woman who is seven weeks pregnant and is currently taking duloxetine (Cymbalta). She has a history of recurrent major depressive disorder (MDD) and has had a good response to duloxetine at 60 mg per day. She has had four previous episodes of major depressive disorder (most untreated) and has been in remission for one year. Past episodes have lasted up to six months and caused difficulty with functioning at work and in relationships, although she was not diagnosed and treated until one year ago.

By MGH Center for Women's Mental Health|2015-08-12T14:50:32-04:00June 29th, 2009|Antidepressants, Pregnancy & Medications|Comments Off

Do SSRIs Increase the Risk of Preeclampsia?

Hypertension in pregnancy is generally defined as a diastolic blood pressure of 90 mm Hg or greater or a systolic pressure at or above 140 mm Hg. Preeclampsia is defined as the development of hypertension with proteinuria or edema induced by pregnancy, generally in the second half of gestation. It is more common in women who have not carried a previous pregnancy beyond 20 weeks and in women at the extremes of the reproductive years.

By MGH Center for Women's Mental Health|2015-07-28T11:31:33-04:00June 22nd, 2009|Antidepressants, Pregnancy & Medications, Pregnancy Outcomes|Comments Off

Pregnancy May Lower Lamotrigine (Lamictal) Blood Levels

Women with bipolar disorder are at increased risk for recurrence of illness during pregnancy. Therefore, many women with bipolar disorder elect to continue treatment with medications during pregnancy after weighing the risks and benefits of various treatment options with their physicians. Lamotrigine (Lamictal) is an anticonvulsant used to treat bipolar disorder. While the safety data on this relatively new anticonvulsant in pregnancy is limited, pregnancy registry data suggests that lamotrigine may pose less of a risk to the developing fetus than with older anticonvulsants, such as valproate (Depakote). With lamotrigine emerging as an effective and relatively safe treatment for pregnant women with bipolar disorder, more attention is now being paid to the effects of pregnancy on lamotrigine levels.

By Ruta Nonacs, MD PhD|2025-06-26T09:07:13-04:00May 5th, 2009|Anti-Epileptic Drugs, Bipolar Disorder, Mood Stabilizers, Pregnancy & Medications|Comments Off

Fetal Exposure to Valproate Associated with Lower IQ

There have long been concerns regarding the use of the anticonvulsant valproate (Depakote) during pregnancy. First trimester use of valproate has been associated with a 3-5% risk of neural tube defects, as well as an increased risk of other malformations affecting the heart, limbs, and genitals. A recent report published in the New England Journal of Medicine indicates that in utero exposure to valproate may also result in lower IQ.

By Ruta Nonacs, MD PhD|2025-06-26T09:08:20-04:00April 24th, 2009|Anti-Epileptic Drugs, Bipolar Disorder, Long-Term Outcomes, Mood Stabilizers, Neurodevelopmental Disorders, Outcomes, Pregnancy & Medications|Comments Off

Antenatal Use of SSRIs and QT Interval Prolongation in Newborns

Over the last several years, a number of studies have indicated that exposure to antidepressants near the time of delivery may be associated with poor neonatal outcomes. A recent prospective study from Dubnov-Raz and colleagues published in the journal Pediatrics found an association between QTc interval prolongation in neonates and antenatal exposure to selective serotonin reuptake inhibitor (SSRI) antidepressants. The QT interval is a measurement of the heart's electrical cycle from ventricular depolarization to the end of ventricular polarization. It is determined from an electrocardiogram (ECG) and is corrected for heart rate.

By MGH Center for Women's Mental Health|2015-08-12T14:14:31-04:00March 24th, 2009|Antidepressants, Neonatal Symptoms, Outcomes, Pregnancy & Medications|Comments Off

SSRIs in Pregnancy and Neonatal Distress Syndrome

Most obstetricians are now familiar with the potential for what has become known as neonatal distress syndrome (or "adaptation" syndrome) following third trimester exposure to SSRIs. Some patients still worry about the possibility of their baby developing neonatal distress syndrome, especially if anything unusual happened during the post-delivery experience of an earlier pregnancy. Women may be concerned about whether and to what degree the medication they were on played a role in their infant's distress and whether to continue that medication during a subsequent pregnancy. The following case may help illustrate the decision-making dilemmas.

By MGH Center for Women's Mental Health|2015-08-12T14:01:29-04:00February 17th, 2009|Antidepressants, Neonatal Symptoms, Outcomes, Pregnancy & Medications|Comments Off

PPHN and SSRIs: Another Study Evaluating the Risk

In 2006, Chambers and colleagues published an article linking SSRI use during late pregnancy to an increased risk of persistent pulmonary hypertension in the newborn (PPHN). Based on the results of this analysis, the authors estimated the risk of PPHN to be about 1% in infants exposed to SSRIs late in pregnancy (after 20 weeks). However, subsequent studies did not demonstrate a significant association between PPHN and SSRI usage. A new study, this one relying upon data from the Swedish Medical Birth Register, has observed an elevated risk of PPHN among SSRI-exposed infants.

By MGH Center for Women's Mental Health|2015-08-11T14:44:41-04:00September 16th, 2008|Antidepressants, Neonatal Symptoms, Outcomes, Pregnancy & Medications|Comments Off

St. John’s Wort: Is it Safe for Pregnancy?

St. John's wort (Hypericum perforatum) is an herbal preparation which has been shown, in some studies, to be effective for the treatment of mild to moderate depressive symptoms. St. John's wort is now one of the most commonly used herbal products in the United States and is widely used in Europe.

By MGH Center for Women's Mental Health|2015-08-11T14:14:20-04:00August 5th, 2008|Antidepressants, Depressive Disorders, Pregnancy & Medications, Risk of Malformations|Comments Off

FDA Proposes Major Revision of Prescription Drug Labeling

The U.S. Food and Drug Administration (FDA) has proposed major revisions to prescription drug labeling in order to provide more accurate and helpful information on the effects of medications used during pregnancy and breastfeeding. As it stands, the current system used by the FDA classifies the reproductive safety of medications using five risk categories (A, B, C, D and X) based on data derived from human and animal studies. While widely used to make decisions regarding the use of medications during pregnancy, many have criticized this system of classification, indicating that this type of drug labeling is often not helpful and, even worse, may be misleading.

By MGH Center for Women's Mental Health|2015-08-11T13:41:57-04:00June 10th, 2008|Child Outcomes, Neonatal Symptoms, Pregnancy & Medications, Risk of Malformations|Comments Off

Melatonin in Pregnancy: Is it Safe?

Many women experience some degree of sleep disturbance during pregnancy. For a significant number of women, the sleep disruption may be so severe as to require some type of intervention. In a previous post, we discussed the use of different types of medications to treat insomnia during pregnancy. While these drugs are highly effective, many women with sleep problems inquire about the use of "natural" agents, such as melatonin, during pregnancy.

By MGH Center for Women's Mental Health|2017-04-07T09:30:08-04:00May 30th, 2008|Alternative & Complementary, Child Outcomes, Outcomes, Pregnancy & Medications, Risk of Malformations, Sleep Medications|Comments Off