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Sertraline During Pregnancy - Safe or Not

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Sertraline is an antidepressant that is considered to be safe during pregnancy. This article explains the side effects of Sertraline and other queries.

Written byDr. Asha. C

Medically reviewed byDr. Richa Agarwal

Published At November 3, 2022
Reviewed AtOctober 10, 2024

What Is Sertraline?

Sertraline belongs to a class of antidepressants known as selective serotonin reuptake inhibitors (SSRIs). It treats depression, post-traumatic stress disorder, panic attacks, social anxiety disorder, and premenstrual dysphoric disorder. This drug will improve mood, appetite, sleep, and energy levels and may help restore interest in daily living.

Furthermore, it can reduce fear, unwanted thoughts, anxiety, and the frequency of panic attacks by restoring the brain's natural balance of serotonin.

There are different types of antidepressants available. Selective serotonin reuptake inhibitors (SSRIs) are one class of antidepressants. They are practical and the most commonly prescribed antidepressants during pregnancy.

Some examples are,

Sertraline.

Citalopram (Celexa).

Fluoxetine (Prozac).

Paroxetine (Paxil).

Escitalopram (Celexa).

Why Is Sertraline Used During Pregnancy?

Many women fight against depression and require antidepressants to manage their symptoms. These days, more and more women are taking antidepressants during pregnancy to keep their symptoms in check. Their safety when taking antidepressants during pregnancy is questionable. But researchers say that most antidepressants, especially selective serotonin reuptake inhibitors (SSRIs), are generally considered safe.

Even though birth defects and other problems are possible, the risk is shallow. Psychiatric and gynecological experts say that if a patient with mild depression has no symptoms for at least six months, they can stop using antidepressants under a physician's supervision or during pregnancy. Psychotherapy and lifestyle measures maybe all that is required to manage depression.

The pregnancy can be managed without antidepressants if the following factors are practiced:

Practice yoga and meditation.

Minimize stress.

Talking with a therapist regularly.

Spend time outside.

Exercise more.

In some cases, doctors recommend that both the mother and the baby stay on antidepressants while pregnant if any of the following have occurred:

A history of severe or recurrent depression.

A history of other mental illnesses, like bipolar disorder.

Had a suicidal tendency.

Is Taking Sertraline During Pregnancy Safe?

The family of SSRIs, especially Sertraline, is one of the safest drugs for antidepressants during pregnancy. Yet, for certain expectant mothers, the decision to maintain an SSRI during pregnancy boils down to evaluating the balance between potential risks and benefits.

The side effects of SSRIs during pregnancy are generally minimal. The baby may have side effects if the drug is taken during the last trimester. These include jitters, poor feeding, vomiting, hyperactive reflexes, low blood sugar, irritability, respiratory distress, abnormal muscle tone, and seizures during the first month of life.

The main problem with Sertraline is that it tends to be under-dosed. The normal starting dose is 50 mg, but many individuals will require 150 mg to 200 mg to manage their symptoms effectively. When sertraline treatment has begun, women with low doses find it hard to manage their symptoms. There are questions arising about the risk of miscarriage and whether using SSRIs makes it harder to get pregnant. However, any prescription medicine comes with risks, and currently, no studies address the issue of infertility.

Is Sertraline Safe During Breastfeeding?

While breastfeeding, only a tiny quantity of Sertraline passes into the breast milk. Preterm babies or babies younger than a month have a less mature stomach and intestines than older babies. This may allow more drugs to enter their bloodstream. No problems for breastfed babies were reported when using Sertraline while breastfeeding. A lower chance of withdrawal after birth is seen in breastfed babies who were exposed to Sertraline in the third trimester of pregnancy. Be sure to talk to the healthcare provider about all breastfeeding queries.

Does Taking Sertraline Increase the Risk of Miscarriage?

Miscarriage can happen in any pregnancy. The relationship between sertraline use and miscarriage risk has not been well studied. A study revealed no disparity in miscarriage rates between individuals who filled prescriptions for sertraline during the first 35 days of pregnancy and those who ceased filling prescriptions before becoming pregnant.

Does Taking Sertraline Raise the Risk of Birth Defects?

Every pregnancy begins with a 3-5 percent baseline risk of birth defects. This is known as the background risk. There have been reports of over 20,000 pregnancies where sertraline was used. While some studies have indicated a possible higher risk of heart defects or other birth defects, the majority of studies have not found an increased likelihood of birth defects associated with sertraline use. Overall, the available data do not indicate that sertraline increases the risk of birth defects beyond the background risk.

Could Sertraline Use Lead to Other Complications During Pregnancy?

Some pregnancy complications have been more frequently reported with the use of SSRIs like sertraline during pregnancy. Studies indicate a higher incidence of low birthweight and preterm delivery (delivery before 37 weeks gestation) when SSRIs are used. It has also been observed that untreated depression or anxiety during pregnancy may increase the risk of pregnancy complications. This complicates determining whether these complications are due to the medication itself, untreated depression or anxiety, or other factors.

Some studies have indicated a potentially heightened risk of persistent pulmonary hypertension, a serious lung condition in newborns when SSRIs are used during the latter stages of pregnancy. However, the overall risk of persistent pulmonary hypertension associated with SSRI use during pregnancy remains low, with less than 1 to 2 cases per 1,000 births. A recent analysis combining data from multiple studies has suggested a potential elevation in the risk of persistent pulmonary hypertension with SSRI use during pregnancy but could not definitively attribute this to medication exposure alone, as other common factors among pregnant individuals taking SSRIs, such as higher rates of smoking, may also contribute.

Should Individuals Change Their Medication?

The decision to discontinue or switch the antidepressant depends on how well the depression is managed. Discuss this with the healthcare provider. Concerns about risks should be balanced against the possibility that a different medication might be ineffective, potentially causing the depression to return.

What Are the Effects of Taking Sertraline Throughout Pregnancy?

Some drugs taken during pregnancy can cause withdrawal symptoms in a newborn after delivery. Taking Sertraline during delivery can cause irritability, tremors (shivering), constant crying, problems with eating and controlling body temperature, jitteriness, different sleep patterns, and some issues with breathing in babies. However, in most cases, the baby experiences mild symptoms that fade within a couple of weeks without any treatment. In some cases, babies may need to stay in the NICU until they are normal.

Conclusion

Selective serotonin reuptake inhibitor (SSRI) drugs like Sertraline are commonly consumed during pregnancy. However, it is crucial to know the positive and negative sides of using a drug during pregnancy. Even though there are certain risks to taking antidepressants during pregnancy, untreated depression can cause more harm for both mother and baby. So, consulting a physician for an opinion is advisable.

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Frequently Asked Questions

Sertraline is considered safe during pregnancy. Some studies reveal that it might affect the baby’s heart development. However, the risks associated are minimal.
Some Selective Serotonin Reuptake Inhibitors (SSRIs) like Citalopram and Sertraline are considered to be safe antidepressants in pregnancy. SSRIs are considered the best options for antidepressants during pregnancy as they pose the lowest risk for the baby. These drugs do not cause a birth defect and are safe to be used in pregnancy.
The pregnancy category for Sertraline is C. It shows that the drug is safe to be taken in pregnancy. These drugs are not known to cause any birth defects. However, their risks cannot be ruled out completely.
It is a misconception that taking antidepressants during pregnancy can be harmful to the baby. Drugs like Sertraline are considered pregnancy-safe. However, it is always recommended to take any medicine after consulting a doctor.
Most studies show that SSRIs are pregnancy-safe. However, drugs like Paroxetine have a risk of affecting the baby’s heart development. Medical advice must be sought on whether to take the drug during pregnancy.
Sertraline can have a high suicidal tendency when started or when the dosage is altered. It can also cause bleeding due to its anti-platelet effect. Sertraline prevents platelet aggregation, causing its anti-platelet effect.
Sertraline passes the placenta and reaches fetal circulation. However, they are considered safe during pregnancy. However, probable risks can be associated, though minor.
Therapy should be considered for depression. The therapist may suggest medicines and advise to start new activities that may help with the depression. Self-care should be given importance. Joint communities can help cope with depression. 
Sertraline can be used at any time of the day, though it is suggested to take it at night if it causes sedation or fatigue. It is advised to be consumed once a day. It can be taken along with or without food. 
Drugs like Sertraline should be tapered in dosage to prevent any adverse effects. Medical advice should be sought on how to taper the drug. The dosage should be changed only with a doctor’s advice.
Studies show that Sertraline can affect Hcg levels. They can elevate the HCG levels. These rises are detectable by pregnancy kits.
The withdrawal symptoms can be seen within five days after the drug is stopped and may last one to two weeks. It can also be seen as the doses are tapered.
Sertraline is usually not sedative but can help to sleep calmly, as it reduces anxiety. However, if it makes one feel sleepy, it is recommended to take it at night. The drug should be used once a day.
Sertraline is not found to have any effect on progesterone. However, it increases the serotonin levels. This elevates mood and reduces anxiety. They belong to a group of drugs called SSRIs.
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