December 1st, 2017

Study: panic doesn’t increase adverse effects for pregnant women

Neither panic disorder nor generalized anxiety disorder increased adverse birth outcomes for pregnant women, according to a recent Yale study.

However, women who used antidepressants and benzodiazepines to treat those conditions saw a slight increase in some adverse outcomes, according to the study, which appeared in the journal JAMA Psychiatry.

Lead author Kimberly Yonkers, M.D., professor of psychiatry, epidemiology and obstetrics, gynecology, and reproductive sciences at Yale School of Medicine, as well as director of the Center for Wellbeing of Women and Mothers, said a major take-home message from the study is that women are not harming their babies if they suffer from one of these psychiatric conditions.

As for those women who require treatment with those medications during pregnancy, she said the findings do not suggest they should discontinue treatment, but rather, work together with their doctors to find the lowest possible dosages and adhere to good health habits like healthy diet and exercise and avoidance of cigarettes and alcohol.

“Taking any medication during pregnancy is not an issue women take up lightly,” Yonkers said. “I think many women will try and discontinue medication that their doctor agrees can be discontinued either before pregnancy or at the beginning of pregnancy but many women have tried to stop or decrease medication prior to pregnancy and find that they cannot tolerate it without a relapse.

“Some women will do well with psychological treatments alone and some also need medication. It is an individual decision. Women should be apprised of the risks.”

Women have the right to discuss their illness and its treatment with their care providers and they should not feel judged if they decide that they need medication in pregnancy, Yonkers said. “Clinicians should try and minimize medication if possible but not against the best interests of their patients.”

“As clinicians we need to respect that and we need to work with them to find alternatives to medication such as psychotherapy or augmenting treatments to medications such as psychotherapy,” Yonkers said.

The Yale team followed 2,654 pregnant women at 137 clinical practices in Connecticut and Massachusetts to assess the impact of psychiatric disorders on pregnancy outcomes. They did not find that maternal or neonatal outcomes were worse in the women who had panic disorder or generalized anxiety disorder compared to women without these conditions.

For those with medication, most medication exposure occurred early in pregnancy. They found that maternal use of benzodiazepine, commonly prescribed for panic and general anxiety disorder, led to slightly lower birthweight (117 additional low birth weight infants per 1,000 births), and their babies needed ventilator support in an additional 61 of 1,000 births.

Gestation was shortened by 3.6 days, and there was a greater chance of cesarean delivery (200 additional cesarean deliveries per 1,000 births).

Among women who were treated with the common class of antidepressants known as serotonin reuptake inhibitors (SRI), gestation was shortened by 1.8 days compared to those who did not take medication, and there were 43 additional pre-term births per 1,000.

Additionally, those treated with SRIs saw 152 additional newborns needing minor respiratory interventions per 1000 births. Antidepressants were linked to hypertensive diseases among pregnant women (53 additional cases of hypertensive diseases per 1000 births).

While the use of medication shortened gestation by a small amount, the authors saw no association between medication use and fetal growth.

By Pamela Berard

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