Management of Sertraline During Pregnancy

Primary Recommendation

The American Academy of Pediatrics recommends that SSRI treatment, including sertraline, should be continued during pregnancy at the lowest effective dose, because withdrawal of medication may have harmful effects on the mother-infant dyad 1, 2

Neonates exposed to sertraline late in the third trimester may develop transient complications including crying, irritability, tremors, poor feeding, hypertonia, tachypnea, sleep disturbance, hypoglycemia, and rarely seizures, which typically resolve within 1-4 weeks and are generally mild 1, 2
Multiple reviews have not identified adverse neurodevelopmental outcomes among infants born to women treated with SSRIs during pregnancy 1, 2

When treating pregnant women with sertraline in the third trimester, continue treatment at the lowest effective dose rather than discontinuing, and arrange early follow-up after delivery as infants are at risk for withdrawal or toxicity symptoms over the first week of life 1, 2
Monitor infants carefully for irritability, feeding difficulties, and respiratory symptoms, and inform pediatric team about maternal sertraline use so they can anticipate and manage neonatal adaptation syndrome if it occurs 1, 2

Sertraline is one of the most commonly prescribed antidepressants during pregnancy and breastfeeding, with a well-established safety profile, and is associated with a possible risk of persistent pulmonary hypertension of the newborn (PPHN) with late pregnancy exposure, with a number needed to harm of 286 to 351 3
The combination of sertraline and trazodone may pose a theoretical risk of serotonin syndrome, though this is rare at therapeutic doses, and patients should be monitored for signs including tremor, diarrhea, delirium, neuromuscular rigidity, and hyperthermia 3, 4
Untreated depression during pregnancy is associated with premature birth and decreased initiation of breastfeeding 3