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Use of Escitalopram during Pregnancy Navigating Towards International Guidelines and the Real World

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Abstract

Maternal psychiatric disorders commonly considered as moderate may have a devastating impact on the fetus and the newborn. Thus, treating or preventing relapse of these disorders during pregnancy is a clinical and ethical duty, despite the fact that the need for rapid maternal symptomatological improvement appears to be at odds with the necessity to avoid fetal drug exposure. Several guidelines and comprehensive reviews have been published to help clinicians faced with this difficult clinical decision. However, the uptake of these recommendations into clinical practice appears to have been less than complete, as suggested by the present case of a patient who was administered escitalopram throughout pregnancy. In this case, there was a healthy outcome for the child. However, this should not detract from the necessity to tackle the problem of inappropriate prescribing of psychotropic agents in pregnancy. Utilization of an integrated clinical approach, monitoring of drug levels throughout pregnancy and routine documentation of the health of the neonate are important measures that should be implemented and promoted to ensure optimal management of antenatal psychiatric disorders and minimize the effects of treatment on the newborn.

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Acknowledgements

No sources of funding were used to assist in the preparation of this case report. The author has no conflicts of interest that are directly relevant to the content of this case report. The author is very grateful to Dr Bengt Källén who kindly provided as yet unpublished data on pregnancy outcome following early in utero exposure to escitalopram.

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  1. Department of Mental Health, Mental Health Center n. 4, ASL Salerno 1 - Piazza Galdi, 841013, Cava de’ Tirreni (Salerno), Italy

    Salvatore Gentile

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  1. Salvatore Gentile
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Correspondence to Salvatore Gentile.

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Gentile, S. Use of Escitalopram during Pregnancy Navigating Towards International Guidelines and the Real World. Clin. Drug Investig. 28, 735–739 (2008). https://doi.org/10.2165/00044011-200828110-00006

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