Two positive lines on a pregnancy test, and a bottle of citalopram in the bathroom cabinet. For a lot of people, the first instinct is to stop the pill that same morning. Please don’t do that yet. The research on Celexa during pregnancy (generic name citalopram) is some of the most extensive for any medicine used by expectant parents, and most of it is more reassuring than people expect. This digest goes through it one question at a time: what large studies actually found, and what that means for the choice you and your prescriber will make together.
Some quick background. Celexa is a selective serotonin reuptake inhibitor (SSRI) made by AbbVie (formerly Allergan), used mainly for depression. It is the parent molecule of escitalopram (Lexapro), which we compare in our Celexa and Lexapro breakdown. Everything below is about pregnancy and nursing, not general use.
Quick answers
Is it safe to take Celexa during pregnancy?
No medicine can be called risk-free in pregnancy, but citalopram is not considered a major cause of birth defects. The best studies point to small or no increases in most risks once the effect of depression itself is accounted for. Leading obstetric guidance treats SSRIs as first-line medicines for moderate to severe depression in pregnancy.
Should I stop citalopram when I find out I’m pregnant?
Not on your own. Stopping suddenly can cause withdrawal symptoms and raises the chance of a depression relapse, which carries its own risks for you and the baby. Call your prescriber or obstetric provider soon, keep taking your dose until you talk, and make any change as a planned decision together.
Can I breastfeed while taking Celexa?
Usually, yes. Citalopram passes into breast milk in larger amounts than sertraline or paroxetine, so some experts prefer those for a brand-new or premature baby. Even so, lactation references rate citalopram as compatible with breastfeeding. Watch the baby for unusual sleepiness, poor feeding or slow weight gain, and report any of these to the pediatrician.
How to read the rest of this digest: each section below asks one question. “What the studies found” summarizes the evidence. “What it means for you” turns it into plain terms. One idea comes up over and over: many studies compare pregnant people taking antidepressants with healthy pregnant people who aren’t depressed. That makes the medicine look worse than it is, because depression, anxiety, smoking, stress and genetics travel together. The better studies compare people with the same illness, or even siblings within the same family.
Does Celexa during pregnancy cause birth defects?
What the studies found
Two very large studies shape this question. The first, published in the New England Journal of Medicine in 2014 by Huybrechts and colleagues, looked at 949,504 pregnancies in the US Medicaid program from 2000 to 2007. About 46,000 of those women filled an SSRI prescription in the first trimester. At first glance, heart defects were somewhat more common in exposed babies: about 90 per 10,000 versus 72 per 10,000. When the researchers limited the comparison to women who had depression and adjusted for other factors, that gap mostly disappeared (relative risk 1.06, which was not statistically meaningful). The study grouped SSRIs together rather than reporting citalopram on its own.
The second, a 2015 BMJ study by Furu and colleagues, pooled more than 2.3 million births from five Nordic countries. Around 11,000 babies had first-trimester citalopram exposure. In the whole population, citalopram was linked to a small rise in birth defects overall (adjusted odds ratio about 1.19), while its link to heart defects specifically was not statistically significant. The key step came next: the team compared siblings, where one child was exposed and another was not. In that comparison, the link between SSRIs and birth defects (any type, or heart) went away. The authors concluded that their results did not support SSRIs as a cause of birth defects.
The current US prescribing information for Celexa reflects this. It says the available human data have not established an increased risk of major birth defects.
What it means for you
About 3 in every 100 babies are born with some birth defect, whether or not the parent takes any medicine. If citalopram adds anything to that, the amount appears small, and sibling studies suggest much of the extra risk seen in crude numbers comes from family and health factors rather than the drug. Major organs form in roughly the first 10 to 12 weeks. If you were taking Celexa when you conceived, that exposure is not a reason to panic. It is a good reason to schedule your anatomy ultrasound as usual and talk with your provider.
Does citalopram raise the risk of miscarriage?
What the studies found
Two large Danish registry studies tackled this directly. In one (Kjaersgaard, 2013), with about one million pregnancies, women who had a depression diagnosis and took an antidepressant had the same miscarriage risk as women with depression who did not. In the other (Andersen, 2014), with nearly 1.3 million pregnancies, SSRI use early in pregnancy was linked to slightly higher odds of miscarriage. But women who had stopped their SSRI 3 to 12 months before getting pregnant had almost exactly the same raised odds. That pattern points to the underlying condition, not the pill. The MotherToBaby fact sheet on citalopram and escitalopram also notes no increased miscarriage risk in the research it reviewed.
What it means for you
Roughly 1 in 10 known pregnancies ends in miscarriage in the general population. Stopping citalopram does not seem to lower that number in any meaningful way, so this one finding alone isn’t a good reason to quit treatment. If you have had a previous loss, tell your provider; it is worth talking about, but it does not usually change the medication plan by itself.
Preterm birth and low birth weight: is there a link?
What the studies found
This is one of the more consistent signals. A Swedish study of over 1.5 million births, published in JAMA in 2017 by Sujan and colleagues, found that first-trimester antidepressant exposure was tied to a slightly higher chance of preterm birth, about 1.3 times that of unexposed babies, even after accounting for many family factors. The same study found no added risk of poor fetal growth once those factors were controlled. The researchers themselves described the preterm increase as slight.
MotherToBaby adds the other half of the story. Some studies suggest a possible rise in preterm birth (before 37 weeks) and low birth weight (under about 5 pounds 8 ounces) with citalopram, but depression itself also raises both risks. So the cause is hard to pin down.
What it means for you
Most babies exposed to Celexa during pregnancy are born at term. A 1.3-fold increase sounds large, but it applies to a starting risk of about 1 in 10 births, and untreated depression is linked to preterm birth too. Keep all your prenatal visits and learn the warning signs of early labor, such as regular tightening, low back pressure or fluid leaking, so you can call your care team quickly.
Neonatal adaptation syndrome after third-trimester exposure
What the studies found
The Celexa label describes newborns exposed to citalopram or other SSRIs late in the third trimester who needed longer hospital stays, breathing support or tube feeding. Reported signs include breathing trouble, jitteriness, tremor, feeding problems, low blood sugar, unstable temperature, irritability and constant crying, and rarely seizures. Experts think this is either a short-lived drug effect or a mild withdrawal in the baby.
How often does it happen? Estimates vary wildly, from 5% to 85%, but the American College of Obstetricians and Gynecologists (ACOG) says most studies land between 10% and 30% of exposed babies. Symptoms usually start in the first few days and fade within about two weeks, with no evidence of lasting harm.
What it means for you
Many people on Celexa during pregnancy assume the fix is to taper off in the last few weeks. ACOG specifically recommends against routinely tapering before delivery. Observational data show no benefit for the baby, and tapering raises the chance that depression returns right when the postpartum period begins. A better plan: give birth in a hospital where a pediatric team can check your baby, and tell the labor and delivery staff that you take Celexa so they know what to watch for.
Persistent pulmonary hypertension of the newborn (PPHN)
What the studies found
PPHN is a rare but serious condition in which a newborn’s lung blood vessels don’t relax after birth, so the baby struggles to get enough oxygen. In 2006, a case-control study reported a roughly six-fold higher risk in babies exposed to an SSRI after 20 weeks of pregnancy. Later studies conflicted. In its December 2011 Drug Safety Communication, the FDA said the evidence was not strong enough to conclude that SSRIs cause PPHN. It advised clinicians not to change how they treat depression in pregnancy because of this concern.
For context, PPHN affects 1 to 2 babies per 1,000 live births in the general population. MotherToBaby notes that even with SSRI use in the second half of pregnancy, the overall chance stays under 1%.
What it means for you
Put simply, among people who take an SSRI such as Celexa during pregnancy, more than 99 out of 100 babies exposed to an SSRI late in pregnancy do not develop PPHN. It is still one reason to deliver where newborn care is available, and to make sure the pediatric team knows about your medicine.
Postpartum hemorrhage: is bleeding after birth more likely?
What the studies found
SSRIs affect how platelets help blood clot, which is why easy bruising appears among Celexa’s side effects. Observational studies suggest that taking an SSRI in the month before delivery is linked to a less-than-two-fold rise in the risk of heavy bleeding after birth. The UK medicines regulator flagged this in a 2021 drug safety update, and the current US Celexa label now includes the same language. One US study cited by ACOG found about 47% higher risk when SSRI users were compared with people who had mood or anxiety disorders but weren’t on an SSRI.
What it means for you
This is a small added risk, and delivery teams are trained to manage bleeding. It matters more if you have other bleeding risks: a clotting disorder, a history of heavy bleeding, twins, or blood-thinner use. If you take Celexa during pregnancy, tell your obstetric team so they can include it in their bleeding plan. Don’t stop the medicine for this reason without talking to them.
Long-term development and autism
What the studies found
Early studies reported links between prenatal antidepressant exposure and autism or ADHD. Better-designed studies have mostly explained those links away. In the Swedish JAMA study mentioned above, the link to autism and ADHD vanished after accounting for family factors. Even more telling, children had a raised risk when the father took antidepressants during the pregnancy, or when the mother took them only before pregnancy. Neither of those can expose the baby to the drug in the womb. That points to shared genes and environment, not the medicine. MotherToBaby’s review agrees: most studies find no increased autism risk once family history is considered.
Not every question is settled. At a July 2025 FDA expert panel on SSRIs in pregnancy, some speakers raised concerns about mood symptoms in teens exposed before birth, and noted that no randomized trials have tested SSRIs in pregnancy. ACOG publicly criticized the panel as unbalanced, saying it underplayed the harms of untreated perinatal illness. Labels can change over time, so ask your pharmacist whether your Celexa label has any recent updates.
What it means for you
The best current evidence does not show that citalopram causes autism. If autism or ADHD runs in your family, that history is a bigger factor than the medication. It’s fair to raise any worries with your prescriber; a good one will welcome the conversation.
The other side of the scale: untreated depression in pregnancy
Every section above weighs a possible medicine risk. When you think about Celexa during pregnancy, the fair comparison is not “Celexa versus a perfect pregnancy”. It is “Celexa versus depression that may not be treated”. ACOG lists these risks linked to untreated perinatal depression:
- Missing prenatal appointments and less self-care, such as poor eating or sleep
- Higher rates of smoking, alcohol or other substance use
- Preterm birth and low birth weight
- Preeclampsia (dangerous high blood pressure in pregnancy)
- Postpartum depression and difficulty bonding with the baby
- Strain on the relationship with a partner
- Suicide, which ACOG calls a leading preventable contributor to maternal deaths in the US
Relapse is common when treatment stops. In observational data cited by ACOG, 68% of pregnant patients with mood disorders who stopped their medicine relapsed, compared with 26% of those who continued. The Celexa label makes the same point: people who stop antidepressants in pregnancy are more likely to have their depression come back.
Safety first: If your mood is getting worse, or you have thoughts of harming yourself or your baby, call or text 988 (Suicide & Crisis Lifeline) right away, and call your prescriber. If there is immediate danger, call 911. Celexa carries a boxed warning about suicidal thoughts in people under 25, especially when starting or changing a dose, so any shift in mood deserves a quick call.
Celexa during pregnancy, trimester by trimester
Researchers look at different outcomes depending on when exposure happens. This table pulls the findings above into one view. Bring it to your next appointment if that helps.
| Stage | What researchers study most | What the evidence suggests | Questions for your provider |
|---|---|---|---|
| First trimester (weeks 1-13) | Birth defects, miscarriage | No clear causal link after sibling and same-illness comparisons; crude data show small differences | Is my current dose the lowest that keeps me well? Is my anatomy scan scheduled? |
| Second trimester (weeks 14-27) | Fetal growth, start of PPHN exposure window (after week 20) | Poor fetal growth not linked once family factors are controlled; PPHN chance stays under 1% | How will we track my mood as my body changes? Does my dose need adjusting? |
| Third trimester (week 28 to birth) | Neonatal adaptation, PPHN, preterm birth, postpartum bleeding | Temporary newborn symptoms in roughly 10-30%; small rise in preterm birth and bleeding risk | Where should I deliver? Will the pediatric team know about my medicine? What’s our bleeding plan? |
| After birth | Breastfeeding exposure, postpartum relapse | Compatible with nursing; postpartum is a high-risk time for relapse | Should I stay on the same dose? What signs in my baby should I report? |
What ACOG’s 2023 guideline recommends
In June 2023, ACOG published Clinical Practice Guideline No. 5, Treatment and Management of Mental Health Conditions During Pregnancy and Postpartum. Its main points, in plain terms:
- SSRIs are first-line medicines for perinatal depression and anxiety, with SNRIs as reasonable alternatives. Talk therapy is first-line for mild to moderate depression.
- Don’t withhold or stop treatment just because of pregnancy or breastfeeding. ACOG gives this a strong recommendation.
- Past response matters most. For someone with no treatment history, sertraline or escitalopram are reasonable starting choices. For someone already doing well on a medicine, staying on a stable regimen is generally preferred.
- Keep switches to a minimum. Switching drugs means the baby is exposed to two medicines, and it risks losing a treatment that works. Adjusting the dose is usually considered before switching.
- No routine taper before delivery, and no automatic dose cut after birth.
So if citalopram is controlling your symptoms, there is no general rule that you need to move to a “pregnancy-preferred” SSRI. If your prescriber does suggest a change, our citalopram versus sertraline comparison explains how the two differ. Remember that the 40 mg daily maximum and heart-rhythm cautions in our Celexa dosage guide still apply during pregnancy.
Breastfeeding on citalopram
What the studies found
Lactation experts measure exposure using the “relative infant dose” (RID): the share of the parent’s weight-adjusted dose that reaches the baby through milk. An RID under 10% is generally considered compatible with breastfeeding, according to ACOG.
- A 2024 Frontiers in Pharmacology study measured an RID of about 6% for citalopram, compared with about 1% for sertraline and 2% for paroxetine. Citalopram was detectable in some infants’ blood at maternal doses of 20 mg a day or more, but exposure was still small, and the authors saw no reason to advise against nursing.
- The e-lactancia citalopram entry reports a wider RID range of 3.6% to 18.3%, meaning it occasionally goes past 10%. It still rates citalopram as compatible, while preferring other options for newborns and premature babies.
- The Celexa label mentions two reports of breastfed babies with excessive sleepiness, reduced feeding and weight loss. Other sources describe rare cases of brief sleep problems, irritability or colic. Most exposed infants have no short- or long-term problems.
What it means for you
ACOG says patients on SSRIs shouldn’t be discouraged from breastfeeding. If you were stable on a medicine during pregnancy, it shouldn’t be switched after birth. Your baby has also been exposed to citalopram for months through the placenta, so the amount in milk is much lower than what they already received. If you are starting an antidepressant fresh after delivery, especially for a premature baby, your prescriber may prefer sertraline. Either way, watch your baby for:
- Unusual sleepiness, or being hard to wake for feeds
- Poor feeding or weak sucking
- Slow weight gain at checkups
- Ongoing fussiness, irritability or colic-like crying
Report any of these to the pediatrician. Mention your citalopram at every newborn visit, and ask your pharmacist to check before you add any new medicine, including sleep aids or allergy pills.
Don’t stop suddenly
The FDA, ACOG, MotherToBaby and the drug label all agree on this. Quitting citalopram abruptly can bring on discontinuation symptoms: dizziness, “brain zaps,” nausea, irritability, trouble sleeping and flu-like feelings. We go through these in detail in our guide to Celexa withdrawal. More important, it can let depression return at a time when your body is under a lot of strain already.
If you and your prescriber decide that coming off makes sense, perhaps because you have been well for a long time, ACOG suggests a gradual taper over about 2 to 4 weeks, with close follow-up. It also notes that depression usually should be in remission for 6 to 12 months before stopping is considered. Pregnancy and the months after birth are rarely the easiest time to test that.
Here is a short checklist for your first call after a positive test:
- Keep taking your usual dose until you speak to your prescriber.
- Tell them how far along you think you are and how your mood has been.
- List every other medicine and supplement you take.
- Ask whether your current dose is right for this stage, and how often you’ll check in.
- Ask about adding therapy, which works well alongside medication.
Facing the same question with another medicine? We’ve written similar evidence reviews on lorazepam (Ativan) in pregnancy, Adderall while pregnant or nursing and taking amoxicillin while expecting.
Where to get expert help with Celexa during pregnancy
You don’t have to sort through this research alone. These free US services can help:
- MotherToBaby: Specialists answer questions about medicines in pregnancy and breastfeeding. Call 1-866-626-6847, or use the chat or “Ask an Expert” email option on their website.
- National Maternal Mental Health Hotline: Call 1-833-852-6262 (1-833-TLC-MAMA). Free, confidential and open 24/7, with counselors in English, Spanish and more than 60 other languages.
- Postpartum Support International (PSI) HelpLine: Call 1-800-944-4773 (1-800-944-4PPD) and leave a message; a trained volunteer calls back with support and local resources.
- 988 Suicide & Crisis Lifeline: Call or text 988 any time you feel unsafe.
The National Institutes of Health keeps a list of these lines on its Moms’ Mental Health Matters help page.
The bottom line: The largest and best-designed studies of Celexa during pregnancy show no clear increase in birth defects or miscarriage. There are small, real signals for preterm birth, temporary newborn adaptation symptoms and bleeding after delivery, and PPHN remains rare. On the other side sits untreated depression, which carries serious risks of its own. Breastfeeding on citalopram is generally fine with some simple watching of your baby. The right choice is the one you make with your prescriber, based on your history, and not one made in a panic on the day of a positive test.
Medical disclaimer: This article is for general information and is not a substitute for advice from your doctor, midwife, pharmacist or other qualified health professional. Do not start, stop or change any medicine without talking to your prescriber. If you have thoughts of harming yourself, call or text 988 in the US; in an emergency, call 911.
