Are Anti-Anxiety Medications Safe During Pregnancy?

It is not uncommon for women (and sometimes men) to develop an anxiety disorder after a miscarriage. But is it safe for women to use anxiety drugs to control the symptoms in a subsequent pregnancy?

Feelings of anxiety after a miscarriage might be specific to anxiety about a new pregnancy or could be anxiety about life in general. Some may face the choice of whether to use anti-anxiety medications to control anxiety following a miscarriage. For couples who want to try for a new pregnancy, this begs the question of whether or not these drugs are safe in a subsequent pregnancy.

Unfortunately, the research is conflicting about the safety of psychiatric medications during pregnancy, and the answer isn't always clear. Here's what we know about specific drug categories:

Currently, most doctors do not recommend using this class of drugs during pregnancy. Benzodiazepines, such as Valium and Xanax, have been linked by some reports to an increased risk of orofacial clefts, hypotonia, apnea, and feeding difficulties in infants.

Other studies have found no risk of using benzodiazepines during pregnancy, so the matter is still up for debate. Some doctors will, however, still prescribe benzodiazepines during pregnancy in cases where they feel the benefits outweigh the possible risks.

Drugs in the category, such as Prozac (fluoxetine), are technically considered antidepressants. But, research suggests they can also help with anxiety. Researchers disagree about the safety of SSRI use during pregnancy; some studies have found no long-term effects, but others have found evidence of possible neonatal problems for babies exposed to SSRIs during pregnancy.

Currently, the American College of Obstetricians and Gynecologists recommends that decisions about using SSRIs during pregnancy be made on an individual basis but advises against the use of Paxil during pregnancy, when possible.

Some research has also found TCAs, such as Tofranil (imipramine), to be helpful for anxiety as well as depression. Several studies have looked at the use of tricyclics during pregnancy, and none have found conclusive evidence of long-term problems. One 2007 study, however, did find evidence that using tricyclics or SSRIs during the third trimester increased the risk of preterm delivery and complications for the baby at birth.

Many women prefer to avoid drugs entirely during pregnancy, but research is showing that having uncontrolled severe anxiety during pregnancy might cause problems for the baby, too. So, it definitely becomes a question of weighing the risks and benefits. Some women prefer to seek out cognitive-behavioral therapy or other non-drug anxiety treatments instead of (or before trying) pharmaceuticals.

In any case, the choice of whether or not to use anxiety medication during pregnancy is up to you and your doctor. If you are suffering from severe anxiety after a miscarriage, this is an important discussion to have.