Q: I have a prescription for a low dosage of Xanax® for anxiety. Is it safe to take during pregnancy? I haven’t taken any and I haven’t been sleeping well.
A: As you may know, anti-anxiety formulations like Xanax® (alprazolam), Ativan® (lorazepam), and Valium® (diazepine) are in the benzodiazepine or “benzo” medication class. Benzodiazepines are widely prescribed and have been fairly well studied in pregnancy.
In general when we look at outcomes from a medication, we think about birth defects, long-term health issues, immediate problems for the newborn, and breastfeeding. I’ll touch on each one.
No Associated Birth Defects
The question of benzodiazepines and birth defects has been answered, and the answer is reassuring. Several years ago concerns arose about birth defects, specifically cleft lip, but subsequently better studies showed that benzos do not cause anatomical problems.
No Evidence Suggesting Long-Term Health Issues
Long-term studies are not available, so behavioral outcomes aren’t known. Children of parents who have anxiety may also be prone to anxiety, with or without exposure to medications during pregnancy. With about 40 years of common usage, there is no evidence to suggest cause-and-effect behavioral or long-term health problems from benzodiazepines in pregnancy.
Babies born to moms taking benzodiazepines on a regular basis may have some medication in their systems at birth. Since an immature metabolism may take a while to break down the drug, they may seem sedated for several days. As the drug leaves their bodies, withdrawal symptoms, such as tremors, restlessness, and trouble regulating body temperature may occur. Any mom taking benzodiazepines near the time of birth should be sure to inform her healthcare team that the newborn has been exposed.
Some of the medication taken by the mom will get through to the baby during nursing, but the benefits of breastfeeding probably outweigh any small risk of the baby being sedated by the medication. Short acting medications like Xanax® are preferable to medications that take a long time to break down, like Valium. If you do choose to take Xanax® while nursing, be sure to tell your baby’s doctor, so they can watch for signs of medication effect. They also may have more to say about the pros and cons of breastfeeding while taking Xanax®.
Overall it looks like the safety data are reasonable, especially for intermittent “as needed” use of benzodiazepines in pregnancy, but your doctor or midwife should be told about your anxiety and desire for treatment during pregnancy so they are aware of the use of medication and can advise you in your particular situation. Hope this helps!