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.