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Effects of sertraline in pregnancy and during breastfeeding

This worksheet looks at the effects of sertraline in pregnancy and during breastfeeding. This information should not be used as a substitute for medical care or advice from your health care provider.

What is sertraline?

Sertraline is a medication that is used to treat depression, obsessive-compulsive disorder, anxiety disorder, post-traumatic stress disorder, premenstrual dysphoric disorder (a severe form of premenstrual syndrome) and social phobia. Sertraline belongs to a class of antidepressants known as selective serotonin reuptake inhibitors (SSRIs). The trade name for sertraline is Zoloft®.

I am taking sertraline, can it make it difficult for me to get pregnant?

No studies have been done to find out if sertraline can make it harder for a woman to become pregnant.

I just found out I’m pregnant. Should I stop taking Sertraline?

Consult your doctor before making any changes to the way you take this medication. For some women, the benefits of continuing to take an antidepressant during pregnancy may outweigh the possible risks. If you plan to stop taking the drug, your doctor may suggest gradually reducing the dose rather than stopping it abruptly. Suddenly stopping this drug can cause withdrawal syndrome in some people. Also, some people may experience a relapse of symptoms if they stop taking this medication during pregnancy.

Taking sertraline increases the likelihood of miscarriage?

Miscarriage can occur in any pregnancy. Sertraline use and the possibility of miscarriage have not been well studied. One study found no significant difference in miscarriage rates between women who were prescribed sertraline during the first 35 days of pregnancy and those who stopped prescribing it between 3 and 12 months before pregnancy.

Taking sertraline during the first trimester of pregnancy increases the chance of developing birth defects?

Each pregnancy has a 3-5% chance of producing a child with a birth defect. This is called an unpredictable risk. Sertraline is one of the most studied antidepressants used during pregnancy. There are reports of more than 10,000 pregnancies exposed to sertraline during the first trimester. A small number of studies have found an association between sertraline use during pregnancy and birth defects, such as heart defects. However, most studies have shown that women taking sertraline during pregnancy are no more likely to have a baby with a birth defect than women not taking sertraline. Overall, the available information does not suggest that sertraline increases the likelihood of birth defects by more than 3-5% of the unpredictable risk.

Taking sertraline during the second or third trimester of pregnancy may cause other pregnancy complications?

Some studies show that the use of SSRIs, such as sertraline, during pregnancy may contribute to pregnancy complications such as low birth weight and premature birth (delivery before 37 weeks of pregnancy). It is difficult to say whether these results are due to the action of the drug, the depression itself, or other factors. Two studies have shown that children whose mothers take SSRIs, such as sertraline, in the second half of pregnancy may have an increased risk of developing pulmonary hypertension, a serious lung problem at birth. Other studies have not shown such an association. More research is needed, but if there is an increased risk, it is considered minimal. You should tell your obstetrician and your child’s pediatrician that you are taking sertraline so that you can get additional help if needed.

Studies have also shown that if depression is not treated during pregnancy, there may be an increased chance of pregnancy complications. This makes it difficult to determine what increases the likelihood of these problems – medication or untreated depression.

Will taking sertraline during pregnancy cause long-term behavioral or learning problems for my baby?

One study showed that babies whose mothers took SSRIs during pregnancy scored lower on tests of motor skills than other babies. This was a very small study involving 31 children; about half of these children were exposed to sertraline. Another small study evaluated the behavior of children aged 4 to 5 years. This study found no differences in the behavior of children whose mothers took sertraline or other SSRIs and children whose mothers did not take SSRIs.

I need to take sertraline throughout my pregnancy. Will it cause withdrawal symptoms for my baby??

If you are taking sertraline near birth, your baby may experience some difficulties in the first few days of life. Your baby may have fussiness, vomiting, constant crying, increased muscle tone, irritability, sleep disturbances, tremors, difficulty eating and some breathing problems. Although in most cases these symptoms are mild and go away on their own within two weeks, some children may require special care for several days until the effects of sertraline and withdrawal syndrome wear off. Not all children exposed to sertraline will have these symptoms.

Can you breastfeed while taking sertraline?

When the mother takes sertraline, only a small amount of the drug passes into breast milk. Very small amounts of sertraline and its breakdown product, norfluoxetine, are found in breast milk. Most published reports on sertraline and breastfeeding report no harmful effects on breastfed infants. There have been no long-term studies in infants who received sertraline through breast milk. If you are concerned about any of your baby’s symptoms, talk to your baby’s health care provider. Be sure to discuss all breastfeeding concerns with your health care provider.

If a man takes sertraline, it may affect his fertility (ability to get pregnant from his partner) or increase the chance of birth defects?

No increase in the likelihood of birth defects or pregnancy complications is expected if the baby’s father takes sertraline. In general, parental exposure is unlikely to increase the risk of pregnancy.