Bupropion Use During Pregnancy

Safety Profile in Pregnancy

• Bupropion does not seem to be associated with major congenital malformations or other significant adverse obstetrical outcomes, although data are limited 1
• A small absolute increase in risk has been associated with two specific cardiovascular malformations with first-trimester exposure: left ventricular outflow tract obstruction heart defects and ventricular septal defects (adjusted odds ratio 2.9; 95% CI, 1.5-5.5) 1
• There is a possible increased risk for diaphragmatic hernia (aOR 2.77; 95% CI, 1.34-5.71), though this has a small absolute risk given the rarity of this condition (population prevalence 0.012%-0.031%) 1

Obstetrical Outcomes

• Possible increased risk for spontaneous abortion has been reported 1
• One case report noted poor neonatal adaptation with seizures due to prolonged hypoglycemia as a consequence of severe hyperinsulinism 1
• Long-term outcomes require further research to clarify possible increased risk for ADHD in offspring, though confounding by indication is likely 1

Breastfeeding Considerations

• Bupropion is present in human milk and has been detected in the serum of infants exposed via breastfeeding, though at very low levels (sometimes undetectable) 1
• Limited data (21 cases) show generally no adverse events, but there have been 2 case reports of seizures in breastfed infants 1
• Caution is advised during breastfeeding 1

Clinical Recommendations

• If taking bupropion before pregnancy, engage in a risk-benefit discussion regarding continuing at the current well-tolerated, effective dose or considering intermittent use 2
• Monitor pregnancy carefully, including fetal growth, blood pressure checks, and appropriate weight gain 2
• For breastfeeding mothers on bupropion, monitor infant development carefully and ensure infants are gaining weight appropriately 2

Important Caveats

• Confounding by indication cannot be ruled out in many studies, as the underlying condition (depression or smoking) may contribute to observed risks 1, 3
• The absolute risk of cardiovascular defects, even if increased, remains relatively low 1
• Benefits of treating maternal depression or supporting smoking cessation may outweigh potential risks in many cases 2

Bupropion Safety During Lactation for Postpartum Depression

Safety Profile During Breastfeeding

• Bupropion is present in human milk and has been detected in the serum of breastfed infants, though typically at very low or sometimes undetectable levels 4
• The American College of Obstetricians and Gynecologists notes that there have been rare reports of seizures in breastfed infants whose mothers were taking bupropion, despite generally low transfer into breast milk 4

Clinical Recommendations

• The American Academy of Pediatrics recommends that if bupropion is needed for treating postpartum depression during breastfeeding, the therapeutic dose should be maintained while breastfeeding, and the infant should be monitored carefully for potential adverse effects, particularly vomiting, diarrhea, jitteriness, sedation, and/or seizures 4
• The American College of Obstetricians and Gynecologists suggests considering bupropion as an alternative to stimulants in the perinatal period, particularly for individuals requiring treatment for co-occurring depression, and ensuring appropriate weight gain and developmental milestones 5

Management of Bupropion Use in Pregnancy and Lactation

Clinical Decision‑Making

• Discuss the risks and benefits with pregnant patients already taking bupropion, weighing continuation at the current well‑tolerated dose against intermittent use. 6
• Do not abruptly discontinue bupropion when it is required for daily functioning, because untreated maternal depression carries its own risks for both mother and fetus. 6, 7

Prenatal Monitoring

• Perform regular fetal growth assessments throughout pregnancy for women who continue bupropion. 6
• Conduct routine maternal blood‑pressure checks while on bupropion therapy. 6
• Ensure appropriate maternal weight gain according to gestational guidelines during bupropion treatment. 6

Perinatal Pharmacotherapy for ADHD

• Bupropion may be considered as an alternative to stimulant medications for pregnant women with ADHD, especially when co‑occurring depression also requires treatment, based on the available safety data. 6, 7, 8
• Recognize that bupropion is generally less efficacious than stimulants for controlling ADHD symptoms. 6, 7, 8

Breastfeeding Management

• Maintain the therapeutic bupropion dose at delivery and during breastfeeding, with appropriate infant monitoring. 6, 7, 8
• Monitor breastfed infants for vomiting, diarrhea, jitteriness, sedation, or seizures, and verify that they achieve appropriate weight gain and developmental milestones. 6

Evidence Gaps & Smoking‑Cessation Recommendation

• The U.S. Preventive Services Task Force reports insufficient evidence to support bupropion’s effectiveness for tobacco cessation or for improving perinatal outcomes in pregnant women. 9

Bupropion Use in Pregnancy: Evidence‑Based Considerations

Impact of Untreated Maternal Depression

• Untreated maternal depression is linked to higher rates of spontaneous abortion, preterm birth, and adverse fetal development, based on observational cohort data published in the American Journal of Obstetrics and Gynecology (2024)【10】.

Smoking Cessation in Pregnancy

• The U.S. Preventive Services Task Force (USPSTF) reports that current evidence is insufficient to determine whether bupropion is effective for smoking cessation or improves perinatal outcomes in pregnant women (insufficient evidence)【11】.