Use of escitalopram during pregnancy: navigating towards international guidelines and the real world

Maternal psychiatric disorders commonly considered as moderate may have a devastating impact on the fetus and the newborn. Thus, treating or preventing relapse of these disorders during pregnancy is a clinical and ethical duty, despite the fact that the need for rapid maternal symptomatological improvement appears to be at odds with the necessity to avoid fetal drug exposure. Several guidelines and comprehensive reviews have been published to help clinicians faced with this difficult clinical decision. However, the uptake of these recommendations into clinical practice appears to have been less than complete, as suggested by the present case of a patient who was administered escitalopram throughout pregnancy. In this case, there was a healthy outcome for the child. However, this should not detract from the necessity to tackle the problem of inappropriate prescribing of psychotropic agents in pregnancy. Utilization of an integrated clinical approach, monitoring of drug levels throughout pregnancy and routine documentation of the health of the neonate are important measures that should be implemented and promoted to ensure optimal management of antenatal psychiatric disorders and minimize the effects of treatment on the newborn.