Celexa use in pregnancy relatively safe: study

NEW YORK (Reuters Health) – The antidepressant citalopram
(Celexa) may be used cautiously in pregnant women, according to
a report from Canada. The researchers report no excess birth
defect risk, although an increased risk of “poor neonatal
adaptation syndrome” was seen with late use of the drug.

Symptoms of poor neonatal adaptation syndrome include
jitteriness, irritability, eating and sleeping difficulties,
convulsions, vomiting, and low blood sugar; these symptoms are
usual transient and not life-threatening.

Overall, the researchers say, “our data suggest that
pregnant women who require pharmacotherapy with citalopram may
continue their treatment during pregnancy with close monitoring
of their condition by a qualified medical professional.”

Previous studies investigating the safety of citalopram
during pregnancy failed to demonstrate an increased risk of
birth defects, the authors further explain in the American
Journal of Obstetrics and Gynecology. Nevertheless, some women
choose to discontinue their drug therapy during pregnancy out
of fear of harming the unborn child.

Anna Sivojelezova and colleagues from The Hospital for Sick
Children and the University of Toronto, Ontario, investigated
whether citalopram use during pregnancy was associated with an
increased risk of adverse pregnancy outcomes, including birth
defects and neonatal complications, in 396 women.

The researchers report in that among 108 women exposed to
citalopram during the first trimester, only one baby was born
with a major malformation, a case of umbilical and scrotal
hernia necessitating surgical correction.

The rate of perinatal complications after third trimester
exposure to citalopram was not increased over that in women not
exposed to citalopram, but the risk of neonatal intensive care
unit admission increased fourfold.

The investigators believe that the increased rate of
neonatal intensive care unit admission may have resulted from
an increased incidence of poor neonatal adaptation syndrome,
which has previously been reported after late pregnancy
exposure to citalopram and other so-called selective serotonin
reuptake inhibitors (SSRIs). However, more study is needed to
prove this mechanism beyond doubt, the authors say.

“In summary,” the team writes, “our findings do not support
an association between citalopram with any major teratogenic
risk in humans.”

SOURCE: American Journal of Obstetrics and Gynecology
November 2005.