When should a pregnant woman seek medical attention while taking anxiolytic (anxiety) medication, such as benzodiazepines (e.g., alprazolam (Xanax)) or selective serotonin reuptake inhibitors (SSRIs)?

From the Guidelines

A pregnant woman taking anxiolytic medication, such as benzodiazepines or SSRIs, should seek immediate medical attention if she experiences severe side effects, including difficulty breathing, extreme dizziness, fainting, severe confusion, or suicidal thoughts, as these can be life-threatening and impact both maternal and fetal health. According to a study published in Pediatrics in 2012 1, SSRIs are commonly used to treat depression in pregnant women, but their use can lead to neonatal signs such as continuous crying, irritability, and jitteriness.

Key Considerations for Medical Attention

• Severe side effects, such as difficulty breathing or extreme dizziness, require immediate medical attention
• Increased anxiety despite medication, new or worsening depression, or unusual changes in fetal movement should prompt a call to the healthcare provider
• Considering stopping or changing medication should also be discussed with a healthcare provider to avoid potential harm to both mother and fetus

Medication Safety During Pregnancy

The study 1 highlights that SSRIs, such as sertraline (Zoloft) or fluoxetine (Prozac), are generally considered safer options for managing anxiety during pregnancy, but benzodiazepines like lorazepam (Ativan) may be used for short-term relief under close medical supervision due to their higher risk profile.

Importance of Regular Check-ups

Regular prenatal check-ups are crucial to monitor both maternal mental health and fetal development, ensuring the balance between treating maternal anxiety and minimizing fetal exposure to medications. Untreated severe anxiety can negatively impact pregnancy outcomes through stress hormones and potential behavioral changes affecting self-care, as noted in the context of managing maternal mental health during pregnancy 1.

From the FDA Drug Label

Patients should be advised to notify their physician if they become pregnant or intend to become pregnant during therapy. Benzodiazepines can potentially cause fetal harm when administered to pregnant women If alprazolam tablets are used during pregnancy, or if the patient becomes pregnant while taking this drug, the patient should be apprised of the potential hazard to the fetus

A pregnant woman taking anxiolytic medication, such as benzodiazepines (e.g., alprazolam) or selective serotonin reuptake inhibitors (SSRIs), should seek medical attention immediately if she:

• Experiences any symptoms that may indicate fetal harm
• Has concerns about the potential risks of the medication to her fetus
• Intends to become pregnant or has become pregnant while taking the medication It is essential for pregnant women to inform their physician about their pregnancy or plans to become pregnant, as the physician may need to adjust the treatment plan to minimize potential risks to the fetus. 2 3

From the Research

When to Seek Medical Attention

A pregnant woman taking anxiolytic medication, such as benzodiazepines or selective serotonin reuptake inhibitors (SSRIs), should seek medical attention in the following situations:

• If she experiences any negative effects on the baby or herself, such as preterm delivery, low birth weight, or neonatal adaptation symptoms 4, 5, 6
• If she has concerns about the potential side-effects and long-term effects of pharmacotherapy, both for herself and her offspring 7
• If she is taking benzodiazepines and is at risk of physical dependence and withdrawal symptoms, which can be serious 4
• If she is taking SSRIs and has a history of depression or anxiety, as the risk of major congenital malformations and other adverse outcomes may be increased 8, 6

Signs of Potential Complications

Pregnant women taking anxiolytic medication should be aware of the following signs of potential complications:

• Hypotonia, depression, and withdrawal symptoms in the newborn 4
• Persistent pulmonary hypertension of the newborn (PPHN) 8, 6
• Congenital heart defects 8, 6
• Preterm birth 5, 6
• Low birth weight 4, 5

Alternative Treatment Options

Pregnant women with anxiety or depression may consider alternative treatment options, such as:

• Psychotherapy, which can be an effective alternative to medication for the treatment of depression, anxiety disorders, and insomnia 5
• Antidepressant drugs, such as sertraline and citalopram, which may be safer alternatives to benzodiazepines 8
• Non-pharmacological interventions, such as lifestyle modifications and stress management techniques, which can help alleviate symptoms of anxiety and depression 7