A 25-year-old woman in her first trimester of pregnancy has severe OCD. She wishes to continue pharmacotherapy. Which medication is considered safest in terms of fetal risk, with the most data supporting use in pregnancy?
- A Paroxetine
- B Clomipramine
- C Escitalopram
- D Sertraline ✓
Explanation
Sertraline has the largest published dataset for use in pregnancy among all SSRIs and is not associated with major teratogenicity at standard doses. Paroxetine carries an FDA category D label due to associations with cardiac septal defects (particularly in the first trimester) and should be avoided in pregnancy. Clomipramine (TCA) carries risks of neonatal withdrawal and cardiac effects. While all SSRIs should be used at the minimum effective dose and only when benefits outweigh risks, sertraline is the preferred choice for antenatal psychiatric pharmacotherapy across most international guidelines.
Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.