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Using Xanax During Pregnancy

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There is mixed evidence surrounding the safety of taking Xanax during pregnancy. If you take Xanax and are pregnant or planning on getting pregnant, it is best to talk to your physician about your options.

Xanax is a brand name for alprazolam, a benzodiazepine medication commonly prescribed to treat anxiety and panic disorders. There are many types of anxiety disorders, including generalized anxiety disorder (GAD), panic disorder, and post-traumatic stress disorder (PTSD). Pregnant women suffering from anxiety or who have been diagnosed with an anxiety disorder may have concerns about using medications like Xanax and wonder whether these medications will negatively affect the fetus. There is no simple answer, as different studies concerning alprazolam use during pregnancy have yielded different results.14

Likewise, there is mixed evidence surrounding stress and its impact on the unborn baby; some studies reported that neither GAD nor panic disorder increased the negative outcomes in newborns.2 Other studies have differentiated the type of stress the mother was under, such as severe stress (famine, natural disaster, death in the family) vs. mild to moderate feelings of anxiety or stress in everyday life.1

Before making any decisions, it is extremely important that you talk to your doctor, who will be able to conduct a risk-benefit analysis of your particular situation. They can also educate you on current research surrounding Xanax use during pregnancy. This way you’ll be able to make an informed decision no matter what you course of action you choose.

Anxiety Disorders

The term “anxiety disorder” refers to a type of psychiatric disorder that involves feelings of intense or excessive worry or fear. People with anxiety disorders usually overestimate the level of danger they are in, which prompts these feelings of fear or worry.3

Pregnant women with anxiety
5 major categories of anxiety and anxiety-related disorders are:4

  • Generalized anxiety disorder (GAD): This disorder is characterized by excessive and chronic tension and worry, even in the absence of a trigger.
  • Panic disorder: Individuals experience panic attacks, which are characterized by sudden and recurring episodes of fear accompanied by physical symptoms, such as dizziness, shortness of breath, heart palpitations, and chest pain. Once you have had a panic attack, you may live in fear of having another.
  • Obsessive-compulsive disorder (OCD): Individuals experience chronic, unwanted, and intrusive thoughts and/or feel the need to engage in repetitive and uncontrollable behaviors, such as hand-washing or counting, in attempts to get rid of the thoughts.
  • Post-traumatic stress disorder: This disorder often develops after exposure to a traumatic event in which the individual felt that their physical safety or life was threatened. Symptoms can include flashbacks or intrusive thoughts about the event.
  • Social phobia/social anxiety disorder (SAD): Individuals feel intense anxiety, self-consciousness, and fear when they are in social situations. Some people may just have a phobia in certain situations, such as fear of public speaking, while people who have SAD may experience symptoms of anxiety in any social setting.

Anxiety disorders affect 1 in 5 American adults, or around 18 million people, but women are much more likely to experience these disorders, with 30.5% of women suffering from an anxiety disorder compared to 19.2% of men. Women are more likely than men to experience panic disorder (with a lifetime prevalence of 5.0% versus 2.0% for men), GAD (6.6% versus 3.6%), SAD (15.5% vs. 11.1%) and PTSD (10.4% versus 5.0%); women are also slightly more likely to experience OCD (3.1% vs. 2.0%).5,6

Anxiety disorders can be extremely debilitating, compromising your ability to function and your overall wellbeing. You can become crippled by excessive worry and fear to the point where you can no longer perform activities of daily living, such as shopping, caring for your family, or going to work.

Benzodiazepines, such as Xanax, are often beneficial short-term treatment options for people with anxiety; however, many women who are pregnant or thinking of getting pregnant have justifiable concerns about the safety of taking Xanax while pregnant.

Effects on the Baby

In many instances, whenever a mother takes a drug, the baby takes it too, because the substance passes through the placenta to the fetus. All psychiatric medications, such as Xanax, traverse the placenta, and some studies indicate an increased risk of specific types of congenital malformations, or birth defects, although the risk of birth defects following prenatal exposure to some specific drugs may not be as high as previously thought.7
Fetus consuming pills in womb from mother
The use of Xanax during pregnancy may increase the risk of some of these congenital malformations, but research hasn’t pinpointed the exact level of risk. One long-term study that examined 542 women who used Xanax while pregnant reported “13 live births with congenital anomalies, 263 live births with no congenital anomalies, 47 spontaneous fetal losses, and 88 elective abortions,” and concluded that while there was no pattern of defects or spontaneous abortions, the study was not large enough to provide conclusive results.8

Another report suggests that the overall risk of cleft lip and palate associated with using Xanax (or other benzodiazepines) during the first trimester is believed to be relatively small—around 0.7%.9 The absolute risk is reported to be small, “with around 7 babies born with cleft lip or palate out of every 10,000 exposed to benzodiazepines in the womb,” compared to 6 babies born with cleft lip or palate out of every 10,000 who are not exposed to these drugs.7

A clinical review reports that evidence from the 1970s suggests an increased risk of facial clefts, heart malformations, and “multiple malformations,” but admits that many of the women examined had complicated psychiatric problems and were taking multiple medications, which could have contributed to these defects. The researchers also state that in many of the studies, the majority of infants were reported to have been born normally. The highest risk seems to be using benzodiazepines during the third trimester or exposure while in labor.10

Overall, data surrounding Xanax use during pregnancy are inclusive. Results from several studies assessing pregnancy outcomes revealed a number of birth defects in newborns, but no causal relationship was found between alprazolam use and the anomalies.14 In fact, data gathered from 9 studies suggested that the use of benzodiazepines during pregnancy does not increase the risk of birth defects in newborns. As you can see, the research surrounding this topic is conflicting. Much more research needs to be conducted to find a definitive answer, but a great deal of experts in the field consider the risk, if any, to be rather small.14

Pregnant women taking pills
Chronic benzodiazepine use can lead to dependence in both the mother and the fetus, especially when taken late in the course of pregnancy and at high doses. Some newborns may experience withdrawal symptoms at birth, which may include:7,9,10

  • Sedation.
  • Restlessness.
  • Diarrhea and vomiting.
  • Decreased muscle tone.
  • Reluctance to suck.
  • Apneic spells (meaning periods of difficult or stopped breathing).
  • Cyanosis (bluish skin).
  • Impaired response to cold-induced stress.
  • Seizures (although rare).

Because of the fetal risks of Xanax discontinuation, a doctor may continue prescribing Xanax to the dependent woman throughout her pregnancy, even if her clinical symptoms have dissipated.14

Another example of a possible complication for the baby is that of floppy infant syndrome, which includes symptoms like:7

  • Lethargy.
  • Poor respiration.
  • Difficulty feeding.

It’s important to keep in mind that there is still some controversy regarding the safety of benzodiazepine use during pregnancy, and many doctors still prescribe them to manage the symptoms of anxiety. In fact, between 21-33% of pregnant women are thought to receive psychotropic medications (drugs that impact a person’s mental state), many of which are prescribed to manage mental health conditions that existed prior to pregnancy.14

Risks of Untreated Anxiety

Symptoms of anxiety can worsen if left untreated and can have negative consequences on both the mother and the fetus. For instance, pregnant women with an untreated anxiety disorder may have a higher risk of early delivery and miscarriage.7 Studies have also found that an increase in both anxiety and other symptoms of anxiety disorders is common both before and after birth. Although data is limited, it seems that specific anxiety disorders, such as OCD and GAD, occur with higher frequency in postpartum women than in the general population, which, if severe enough, could impair the mother’s ability to care for her child.11 There is also an increased risk of anxiety relapse both when women become pregnant and during the postpartum period, whether they take medication or not.12

Regardless of who is affected, anxiety disorders are debilitating and distressing conditions that can greatly reduce a person’s quality of life. Symptoms, such as excessive worry, panic attacks, obsessive thoughts, and intense fear may make it extremely difficult for a person to function in daily life. Failing to fulfill home, work, or school responsibilities can then exacerbate the anxiety symptoms, creating a problematic cycle. Further, anxiety is associated with a number of physical ailments, such as irritable bowel syndrome (IBS), chronic respiratory disease, heart disease, increased risk of heart attack and stroke,

Discussing the pros and cons of continuing Xanax with your physician is important for helping you make the most informed decision for your and your baby’s health.

Sources

  1. Emory Maternal Substance Abuse and Child Development Project. (2007). The Effects of Maternal Stress and Anxiety During Pregnancy
  2. Yonkers, K., Gilstad-Hayden, K., Forray, A., & Lipkind, H. (2017). Association of Panic Disorder, Generalized Anxiety Disorder, and Benzodiazepine Treatment During Pregnancy With Risk of Adverse Birth OutcomesJAMA Psychiatry, 74(11), 1145–1152.
  3. American Psychiatric Association. (2013). The Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
  4. U.S. Department of Health and Human Services. (2014). What are the Five Major Types of Anxiety Disorders?
  5. Anxiety and Depression Association of America. (N.D.). Facts and Statistics.
  6. McLean, C. P., Asnaani, A., Litz, B. T., & Hofmann, S. G. (2011). Gender Differences in Anxiety Disorders: Prevalence, Course of Illness, Comorbidity and Burden of IllnessJournal of Psychiatric Research45(8), 1027–1035.
  7. Harvard Mental Health Letter. (2008). Prescribing During Pregnancy
  8. St. Clair, S. & Schirmer, R. (1992). First-Trimester Exposure to Alprazolam. Obstetrics and Gynecology, 80(5), 843–6.
  9. Massachusetts General Hospital. (2001). Benzodiazepines and Pregnancy.
  10. McElhatton, P. (1994). The Effects of Benzodiazepine Use During Pregnancy and Lactation. Reproductive Toxicology, 8(6):461–75.
  11. Ross, L. &McLean, L. (2006). Anxiety Disorders During Pregnancy and the Postpartum Period: A Systematic Review. Journal of Clinical Psychiatry, 67(8), 1285–98.
  12. Altshuler, L., Hendrick, V. & Cohen, L. (1998). Course of Mood and Anxiety Disorders During Pregnancy and the Postpartum Period. Journal of Clinical Psychiatry, 59 Suppl 2, 29–3.
  13. Harvard Health Publishing. (2017). Anxiety and physical illness.
  14. Ait-Daoud, N., Hamby, A.S., Sharma, S., & Blevins, D. (2018). A Review of Alprazolam Use, Misuse, and Withdrawal. Journal of Addiction Medicine, 12(1), 5-6.

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