From the FDA Drug Label
There are no adequate and well-controlled studies in pregnant women. Sertraline hydrochloride should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus Pregnancy-Nonteratogenic Effects Neonates exposed to sertraline and other SSRIs or serotonin and norepinephrine reuptake inhibitors (SNRIs), late in the third trimester have developed complications requiring prolonged hospitalization, respiratory support, and tube feeding. Infants exposed to SSRIs in pregnancy may have an increased risk for persistent pulmonary hypertension of the newborn (PPHN).
The safest anxiolytic medication for a pregnant woman in her first trimester cannot be determined from the provided information. The FDA drug labels for sertraline 1 and 1 do not provide a clear answer to this question, as they both indicate that there are no adequate and well-controlled studies in pregnant women, and that the use of sertraline during pregnancy should only be considered if the potential benefit justifies the potential risk to the fetus. Key considerations for the use of sertraline in pregnant women include:
- Potential risks to the fetus, such as persistent pulmonary hypertension of the newborn (PPHN)
- Potential complications for neonates, such as respiratory distress and seizures
- The need for careful consideration of the potential benefits and risks of using sertraline during pregnancy on a case-by-case basis.
From the Research
The safest anxiolytic medication for a pregnant woman in her first trimester is buspirone, as it has shown no major malformations in a prospective longitudinal study 2. When considering anxiolytic medications for pregnant women, it is essential to weigh the potential risks and benefits.
- Selective serotonin reuptake inhibitors (SSRIs) like sertraline are often considered first-line options, but they carry some risk.
- Benzodiazepines like lorazepam should be avoided due to potential risks of cleft palate and neonatal withdrawal, as highlighted in a study on benzodiazepine use in pregnancy 3.
- Non-medication approaches such as cognitive behavioral therapy, mindfulness practices, and regular exercise should be tried first whenever possible.
- If medication becomes necessary, the lowest effective dose should be used for the shortest duration needed, and this decision should be made in consultation with both an obstetrician and mental health provider. A study on the reproductive safety of different SSRIs found that sertraline and citalopram have a relatively safer profile compared to other SSRIs, but buspirone has emerged as a safer alternative in recent studies 4, 2. It is crucial to prioritize the mother's mental health needs while minimizing potential risks to the developing fetus, and buspirone has shown promising results in this regard 2.