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Date of issue: January 2017
Version: 2.2

This is a UKTIS monograph for use by health care professionals. For case-specific advice please contact UKTIS on 0344 892 0909. To report an exposure please download and complete a pregnancy reporting form. Please encourage all women to complete an online reporting form.

A corresponding patient information leaflet on escitalopram use in pregnancy is available at


Escitalopram is a selective serotonin reuptake inhibitor (SSRI) used in the treatment of depression, panic disorder, with or without agoraphobia, generalised and social anxiety disorder, and obsessive-compulsive disorder.

Although limited, data on the risk of congenital malformation following escitalopram use in early pregnancy are generally reassuring. The available studies provide no evidence of an increase in overall congenital malformation rate, and the majority of studies investigating specific cardiovascular malformations have failed to identify an increased risk for escitalopram-exposed infants. However, single studies have associated escitalopram use in early pregnancy with possible increased risks of atrioventricular septal defects, Tetralogy of Fallot and Ebstein’s anomaly specifically. These findings, which may be confounded, require confirmation in future studies.

Debate as to whether other individual SSRIs, or SSRIs as a class, are cardiac teratogens continues. As escitalopram is relatively under-investigated in this regard, more robust data are needed before an increased risk of cardiac malformation can be excluded.

The incidence of spontaneous abortion, preterm delivery or intrauterine death has not been shown to be increased following escitalopram exposure in a small number of studies. However, a single study has provided evidence of a possible increase in the risk of low birth weight. As the available data are limited, the possibility of an increased risk for any of the above outcomes cannot be excluded.

In utero exposure to any SSRI in the weeks prior to delivery confers a risk of transient neonatal withdrawal syndrome and infants should be monitored for associated central nervous system, motor, respiratory and gastrointestinal symptoms. An increased risk of persistent pulmonary hypertension (PPHN) of the newborn has also been reported following exposure to SSRIs as a class beyond 20 weeks of gestation and, although this remains an uncommon event (0.2-1.2% vs. 0.1-0.2% in the background population), it represents a potentially serious neonatal complication.

It is important to ensure that maternal mental health is treated appropriately. As such, escitalopram may be suitable for use in pregnancy, but the risks and benefits of use must be considered on a case-by-case basis. Where possible, non-pharmaceutical management of depression and/or anxiety is preferable in pregnancy. Where a patient is stabilised on escitalopram, either prior to conception or during pregnancy, the risk of discontinuing treatment, changing the medication, or reducing the dose, should be carefully weighed against the risk maternal relapse during pregnancy may pose to both mother and child. In cases where treatment with escitalopram is continued in pregnancy, the lowest effective dose should be used. 

At present there is insufficient evidence to warrant additional fetal monitoring. Exposure to escitalopram at any stage in pregnancy would not usually be regarded as medical grounds for termination of pregnancy. However, other risk factors may be present in individual cases which may independently increase the risk of adverse pregnancy outcome. Clinicians are reminded of the importance of consideration of such factors when performing case-specific risk assessments.

This document is regularly reviewed and updated. Only use full UKTIS monographs downloaded directly from to be sure you are using the most up-to-date version. The summaries of these monographs are openly available on

This is a summary of the full UKTIS monograph for health care professionals and should not be used in isolation. The full UKTIS monograph and access to any hyperlinked related documents is available to health care professionals at

If you have a patient with exposure to a drug or chemical and require assistance in making a patient-specific risk assessment, please telephone UKTIS on 0344 892 0909 to discuss the case with a teratology specialist.

If you would like to report a pregnancy to UKTIS please click here to download our pregnancy reporting form. Please encourage all women to complete an online reporting form.

Disclaimer: Every effort has been made to ensure that this monograph was accurate and up-to-date at the time of writing, however it cannot cover every eventuality and the information providers cannot be held responsible for any adverse outcomes of the measures recommended. The final decision regarding which treatment is used for an individual patient remains the clinical responsibility of the prescriber. This material may be freely reproduced for education and not for profit purposes within the UK National Health Service, however no linking to this website or reproduction by or for commercial organisations is permitted without the express written permission of this service. This document is regularly reviewed and updated. Only use UKTIS monographs downloaded directly from or to ensure you are using the most up-to-date version.