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Panic, anxiety medications linked to negative birth outcomes

Panic disorder and generalized anxiety disorder were not associated with adverse birth outcomes; however, using benzodiazepines or serotonin reuptake inhibitors shortened gestation.

“During pregnancy, up to 5% of women have panic disorder and as many as 10% have generalized anxiety disorder (GAD). Although the impact of a maternal major depressive episode has been explored extensively with regard to adverse birth outcomes, attention devoted to anxiety disorders has been sparse,” Kimberly A. Yonkers, MD, of the department of psychiatry, Yale School of Medicine, and colleagues wrote in their study published in JAMA Psychiatry.

To determine if panic disorder, GAD or taking related medications in pregnancy were associated with adverse maternal or neonatal outcomes, researchers evaluated 2,654 women at 137 obstetric practices before 17 weeks of pregnancy and followed up at 28 weeks of pregnancy and 8 weeks postpartum. Study participants had a mean age of 31 years.

Overall, 98 participants had panic disorder, 252 had GAD, 67 received benzodiazepines and 293 received a serotonin reuptake inhibitor (SRI).

Adjusted models indicated neither panic disorder nor GAD was associated with maternal or neonatal complications.

Mothers who used benzodiazepines were more likely to experience cesarean delivery (OR = 2.45; 95% CI, 1.36-4.4), low birth weight (OR = 3.41; 95% CI, 1.61-7.26) and use of ventilatory support for the newborn (OR = 2.85; 95% CI, 1.2-6.9).

Mothers who used a SRI were more likely to experience hypertensive diseases of pregnancy (OR = 2.82; 95% CI, 1.58-5.04), preterm birth (OR = 1.56; 95% CI, 1.02-2.38), and use of minor respiratory interventions (OR = 1.81; 95% CI, 1.39-2.37).

Rates of ventilatory support increased by 61 of 1,000 neonates and duration of gestation decreased by 3.6 days among mothers who used benzodiazepines.

Among those who used SRIs, gestation duration decreased by 1.8 days; 152 of 1,000 neonates required minor respiratory interventions; and 53 of 1,000 additional women experienced hypertensive diseases of pregnancy.

“In general, women are reluctant to take medication in pregnancy, and medication exposures are typically the result of necessity. Often, mothers have the clearest sense of their risk of relapse if medication is discontinued, and this relapse bears on her well-being and that of her offspring,” the researchers wrote. “In addition, treatment may be necessary for the mother to carry the pregnancy to term. Clinicians and patients need to consider both maternal illness and treatment needs in addition to risks associated with offspring when making treatment decisions in pregnancy.” – by Amanda Oldt

Disclosures: Yonkers reports receiving consulting fees from Juniper and Marinus Pharmaceuticals and receiving royalties for a chapter written for Up To Date. The other authors report no relevant financial disclosures.