Lexapro Use In Pregnancy & Lactation

Pregnancy: Limited clinical data are available regarding exposure to escitalopram during pregnancy.
In reproductive toxicity studies performed in rats, embryo-fetotoxic effects (reduced foetal weight and minor delay in ossification) were observed with exposure to escitalopram, but there was no effect on foetal viability and no increased incidence of malformations (see Pharmacology: Toxicology: Preclinical safety data under Actions).
Newborns should be observed if maternal use of escitalopram continues into the later stages of pregnancy, particularly in the third trimester. If escitalopram is used until or shortly before birth, discontinuation effects in the newborn are possible.
The following symptoms may occur in the newborn after maternal SSRI/SNRI use in later stages of pregnancy: respiratory distress, cyanosis, apnoea, seizures, temperature instability, feeding difficulty, vomiting, hypoglycaemia, hypertonia, hypotonia, hyperreflexia, tremor, jitteriness, irritability, lethargy, constant crying, somnolence and difficulty sleeping. These symptoms could be due to either discontinuation effects or excess serotonergic activity. In a majority of instances, such complications begin immediately or soon (<24 hours) after delivery.
Escitalopram should not be used during pregnancy unless clearly needed and after careful consideration of the risk/benefit ratio.
Infants exposed to SSRIs in late pregnancy may have an increased risk for persistent pulmonary hypertension of the newborn (PPHN). PPHN occurs in 1-2 per 1000 live births in the general population and is associated with substantial neonatal morbidity and mortality. Several recent epidemiologic studies suggest a positive statistical association between SSRI use (including Lexapro) in pregnancy and PPHN. Other studies do not show a significant statistical association.
When treating a pregnant woman with escitalopram during the third trimester, the physician should carefully consider both the potential risks and benefits of treatment.
Observational data indicate an increased risk (less than 2-fold) of postpartum haemorrhage following SSRI/SNRI exposure within the month prior to birth (see Precautions, Adverse Reactions).
Breast-feeding: It is expected that escitalopram will be excreted into human milk and breast-feeding is not recommended during the treatment.
Fertility: Animal data have shown that citalopram may affect sperm quality (see Pharmacology: Toxicology: Preclinical safety data under Actions).
Human case reports with some SSRIs have shown that an effect on sperm quality is reversible.
Impact on human fertility has not been observed so far.