- Whether to continue sertraline in pregnancy is an individual decision made with your OB and the prescriber who manages your mental health, not something to change on your own.
- Sertraline is one of the most studied SSRIs and is often considered a preferred option in pregnancy, though "preferred" still means individualized.
- Most studies have not found an increased chance of birth defects; where heart-defect signals appeared, rates were similar in treated and untreated depression, suggesting the condition may play a role.
- Possible studied concerns include a small, uncertain chance of PPHN and temporary newborn adjustment symptoms after birth, usually mild and short-lived.
- Untreated depression in pregnancy carries real risks, so the goal is effective, safe treatment rather than simply stopping.
- The old FDA A/B/C/D/X letter categories are retired; questions can go to MotherToBaby at 1-866-626-6847, and for crisis call or text 988.
If you take Zoloft and you are pregnant or planning to be, you may feel caught between two worries: the medicine and the depression or anxiety it treats. That is a common and understandable place to be. Sertraline is also one of the medicines clinicians most often discuss with people who need an antidepressant during pregnancy, so there is a fair amount of evidence to draw on. This article gathers what leading U.S. sources say so you can have a clearer conversation with the clinicians who manage your care. It is general education only and is not a substitute for that conversation.
What Zoloft is and what it treats
Zoloft is a common brand name for sertraline, a selective serotonin reuptake inhibitor, or SSRI. This medicine family also includes escitalopram, fluoxetine, citalopram, and paroxetine. SSRIs are used to treat depression and several anxiety-related conditions, including panic disorder, obsessive-compulsive disorder, and post-traumatic stress disorder. They work by increasing the availability of serotonin, a chemical messenger in the brain involved in mood. For many people these conditions are ongoing and need steady treatment, which is why decisions about continuing during pregnancy deserve careful, individualized thought rather than a quick yes or no.
What the guidance says about pregnancy
Sertraline is often described as one of the preferred SSRIs in pregnancy, and the evidence behind that is worth understanding. MotherToBaby, a service of the non-profit Organization of Teratology Information Specialists, reports that most studies have not found an increased chance of birth defects with sertraline. Some research suggested higher rates of heart defects, but MotherToBaby highlights an important detail: when pregnant women with depression who used sertraline were compared with those who had depression but did not use it, the rates of defects were similar. That pattern suggests the underlying condition, rather than the medicine, may be responsible for some of what earlier studies attributed to the drug.
The American College of Obstetricians and Gynecologists (ACOG) has taken a clear public position that SSRIs are an important and generally safe option in pregnancy for people who need them, and that most SSRIs do not increase the risk of birth defects. ACOG stresses that these medicines can be part of an effective treatment plan before, during, and after pregnancy.
Specific concerns that have been studied
Being reassured overall does not mean there is nothing to discuss. MotherToBaby describes several areas researchers have examined.
Miscarriage. The evidence is limited but overall reassuring; MotherToBaby reports that studies have not shown that taking sertraline increases the chance of miscarriage, and notes that depression itself may raise that chance.
Preterm birth. Some studies indicated a higher chance of preterm delivery, but this is complicated by the fact that untreated depression or anxiety could also increase pregnancy complications, making cause and effect hard to separate.
Persistent pulmonary hypertension of the newborn (PPHN). Some research suggested SSRI use in the second half of pregnancy might increase PPHN risk, a serious lung condition, but other studies did not confirm this. MotherToBaby notes the baseline rate is about 1 to 2 per 1,000 births, and that if SSRIs do increase the risk, the overall chance is still low, less than 1 in 100.
Newborn adjustment symptoms. Some babies exposed to sertraline late in pregnancy show temporary symptoms after birth, such as irritability, tremors, and feeding difficulties. MotherToBaby reports that in most cases these symptoms are mild and go away on their own within a couple of weeks.
The other side: untreated depression carries risks too
It is easy to focus only on the medicine, but the condition matters just as much. ACOG and MotherToBaby both emphasize that untreated or undertreated depression in pregnancy is not risk-free. It can be associated with poor engagement in prenatal care, inadequate nutrition and self-care, substance use, and pregnancy complications, and MotherToBaby notes depression itself may increase the chance of miscarriage and preterm birth. In serious cases, untreated depression can involve thoughts of self-harm. The goal your care team will aim for is effective, appropriate treatment, not simply stopping medication. For some people the safest plan is to continue; for others a change may make sense. That balance is personal.
Do not start or stop on your own
This is the most important practical point. Do not stop sertraline abruptly on your own. SSRIs can cause discontinuation symptoms when stopped suddenly, such as dizziness, flu-like feelings, sleep disturbance, and mood changes, and stopping can also allow the underlying depression or anxiety to return, sometimes forcefully. If you are worried, the right move is to contact your prescriber and your OB and plan any change together. Likewise, do not start or switch an antidepressant during pregnancy without that same guidance. The decision is individualized and depends on your history, how well the medicine has worked, and how you are doing now.
A note on the old letter categories
You may have seen older references to FDA pregnancy “categories” such as A, B, C, D, and X. That system has been retired. U.S. drug labels now use a narrative format under the Pregnancy and Lactation Labeling Rule, which describes what is actually known rather than assigning a single letter. If you find an old letter grade for sertraline, treat it as out of date and ask your clinician for the current picture.
Breastfeeding
MotherToBaby reports that sertraline passes into breast milk in small amounts, and that most exposed infants have no side effects. Sertraline is frequently discussed as one of the more studied antidepressants during breastfeeding. As always, confirm the plan with your baby’s clinician, especially for a premature or medically fragile infant.
When to call your OB or a specialist
Reach out to your obstetric provider and mental-health prescriber if you are pregnant or planning pregnancy and take sertraline, if you are thinking about stopping or changing it, or if your mood or anxiety worsens. If your situation is complex, your team may involve a maternal-fetal-medicine specialist or a perinatal psychiatrist. For questions about a specific exposure, you can call MotherToBaby at 1-866-626-6847, a free service that answers questions about medicines in pregnancy and breastfeeding. If you ever have thoughts of harming yourself, call or text 988 right away.
Frequently asked questions
Is Zoloft safe to take while pregnant? For many people it can be an appropriate choice, and it is often considered a preferred SSRI in pregnancy, but “safe” is individual. MotherToBaby and ACOG describe SSRIs as generally reassuring and most not linked to birth defects, while noting a few studied concerns. Decide with your OB and prescriber.
I took Zoloft before I knew I was pregnant. Should I worry? Try not to panic. Most research has not linked sertraline to an overall rise in birth defects. Tell your OB what you took and when, and ask questions there or through MotherToBaby.
Will my baby have withdrawal after birth? Some babies show temporary adjustment symptoms such as irritability, tremors, or feeding difficulties. MotherToBaby reports these are usually mild and resolve within a couple of weeks. Your care team can watch for them.
Should I switch to a different antidepressant for pregnancy? Not on your own. The best medicine is often the one that has worked well for you, and sertraline is well studied. Any switch should be planned with your prescriber, because changing can risk relapse.
Can I breastfeed while taking it? MotherToBaby reports only small amounts reach breast milk and most exposed infants have no side effects. Confirm with your baby’s clinician, especially for a newborn or fragile infant.
What if I feel fine and want to stop? Talk to your prescriber first. Stopping abruptly can cause discontinuation symptoms and relapse, and many people benefit from staying on treatment through the higher-risk postpartum period.
This article is general education, not medical advice, and must not be used to start, stop, adjust, or taper any medication on your own. Suddenly stopping some medicines can be dangerous. Always work with the prescriber who manages your care. In an emergency call 911; for mental-health crisis call or text 988.
Sources
- MotherToBaby (Organization of Teratology Information Specialists) — Sertraline (Zoloft) fact sheet.
- American College of Obstetricians and Gynecologists (ACOG) — guidance on treatment and management of mental health conditions during pregnancy and postpartum, and its statement on access to SSRIs during pregnancy.