New Research Suggests Treating Anxiety Doesn't Have to Take a Backseat During Pregnancy

A new study about the safety of benzodiazepines during pregnancy might give mothers some peace of mind about treating anxiety during pregnancy.

For many women, pregnancy is a period of anxiety and stress. Financial worries, fears of about impending parenthood, and concern for the health of child can weigh heavily on women, especially those with histories of mood and psychiatric disorders. However, a new study about the safety of benzodiazepines during pregnancy might give mothers some peace of mind about treating anxiety during pregnancy.
The study, published in JAMA Psychiatry, found a slight increased risk of adverse birth outcomes associated with benzodiazepine and serotonin reuptake inhibitor use during pregnancy, but the risks were minor overall. Women who used benzodiazepines such as Xanax were more likely to deliver by cesarean section. Babies were also more likely to have low birth weights, and six out of every 100 born required the use of ventilators. The average length of pregnancy was also shortened by 3.6 days, the study found.
The use of serotonin reuptake inhibitor (SSRIs) such as Lexapro, Prozac, or Zoloft, had similar effects on the pregnancy. Preterm birth was more likely, and pregnancy was shortened by an average of 1.8 days. An extra 15 out of every 100 babies born required minor respiratory interventions. Women were also at a slightly higher risk (five out of every 100) of high blood pressure.
While the use of these medications are not without risk, the overall effects are fairly minor. For many women, the benefits that come with treating mood disorders may significantly outweigh the slightly shortened pregnancies and extra support required at birth. The authors of the study study say their research suggests women should not feel pressured to stop their medications during pregnancy.
Not all studies have given expecting mothers such comforting news. Past research has suggested that children exposed to long-term benzodiazepine use in utero were more likely to internalize problems at both one-and-a-half and three years of age. Other research has found that children whose mothers used SSRIs while pregnant were more likely to be diagnosed with a psychiatric disorder by age 16 than those whose mothers did not (14.5 percent vs. 8 percent, respectively).
Of course, women with more severe mood disorders which require treatment through pregnancy might be more likely to have children with similar disorders, regardless of their prescription drug usage. The American College of Obstetricians and Gynecologists notes that while anti-anxiety and antidepressant medications during pregnancy may be a concern, discontinuing medication use can present new challenges including a lack of adherence to prenatal care, inadequate nutrition, and increased substance use.
Non-pharmacological treatments can act as a first-line therapy for pregnant women exhibiting mild-to-moderate symptoms of anxiety disorders and depression. For women who are interested in stepping back their pharmacological use during pregnancy, therapies such as bright light therapy, cognitive behavioral therapy, interpersonal therapy, and group therapy have been shown to be effective. But research on non-pharmacological treatments for anxiety and depression in pregnant women is limited, and these treatments may not be sufficient for women with more pronounced mental health needs.
Estimates vary wildly, but as many as 10 to over 50 percent of pregnant women experience anxiety disorders or symptoms at some point during pregnancy. Similarly, about 13 percent of pregnant women and new mothers experience depression. The factors that increase the risk of depression during and after pregnancy are numerous and varied, and include:

  • personal and family history of depression
  • being young, substance abuse, stressful life events
  • marriage or money problems
  • anxiety or negative feelings about the pregnancy
  • problems with previous pregnancies or birth

In January of last year, the US Preventive Task Force recommended that prenatal and postpartum women should be screened for depression. Despite these guidelines, many expecting mothers do not receive any sort of prenatal screening for mood disorders. And early detection may be key. A Dutch study found that women who were screened for postpartum depression at three weeks were less likely to be depressed nine months later than those who were not.
Women who are already receiving treatment for anxiety disorders should discuss with their doctor the benefits and drawbacks of staying on prescription benzodiazepines and SSRIs. With new research highlighting the relatively minor effects on babies’ physical health, mothers should be better equipped to make an informed decision about their treatment.