In the last decade, it has come to light that many women suffer from new onset anxiety disorders or worsening of pre-existing anxiety in pregnancy. But until recently, it was believed that anti-anxiety medications would negatively impact the fetus.
“It’s kind of a tricky balance,” Dr. Kimberly Yonkers, a psychiatrist, and professor at Yale University said to NPR. “People have this illness that they didn’t ask for and don’t want. They’re really suffering.”
Yonkers recently published a study in JAMA that concluded the risks associated with taking benzodiazepine such as Xanax and serotonin reuptake inhibitors (SSRIs) like Prozac, are mild to modest, thus hopefully taking the onus off pregnant women to suffer through their illness.
She looked at the maternal and neonatal outcomes of panic disorder and generalized anxiety disorder (GAD) in nearly 3,000 women from July 2005 to July 2009, and found the disorders themselves did not have negative effects on the babies, while the medications had mild adverse outcomes.
In women who took benzodiazepine, the rates of C-section deliveries were slightly higher (approximately 200 additional C-sections were performed for 1,000 births), newborns were more likely to require ventilatory support (in 61 out of 1,000 births), and there was a moderately higher occurrence of low birth weight. Women who took SSRIs were associated with hypertensive diseases in pregnancy (53 out of 1,000), and minor respiratory interventions of newborns (152 out of 1,000). In both cases, preterm births were more likely — those who took benzodiazepine had a shortened gestation of 3.6 days, and the others were shortened by 1.8 days.
“It’s good for both patients and clinicians to have a sense of [these effects],” Yonkers said to JAMA Psychiatry. “We tried to put the magnitude of these effects in the paper so that they would understand what we’re talking about in terms of mild or moderate risk. An average decrease in gestation of three days is modest.”
Dr. Sophie Grigoriadis, a psychiatrist and head of the Women’s Mood and Anxiety Clinic at Sunnybrook Health Sciences Centre, believes in cases of psychiatric disorders, it’s important to weigh the risks and the benefits before deciding to take a woman off anxiety medication, although she recognizes that it’s a touchy subject.
“This area is extremely controversial,” she tells Global News. “The idea is to try to do what’s best for the mother and her family. This study gives us more pieces of the puzzle; in this study, the authors found adverse effects associated with the medications but not the illness itself. This is but one study and the numbers are fairly small; we need more research. But I would still maintain that we must treat these women with whatever tools we have. If a woman is severely [depressed or anxious], we have to think how she’ll progress through her pregnancy and postpartum without treatment.”
This is especially poignant considering that if a severe psychiatric disorder went untreated, a woman could be more prone to improper nutrition from a lack of self care, or hazardous choices, including drug, alcohol and cigarette use, and even suicide.
“If a woman comes off her medication and psychotherapy doesn’t work for her, that’s not a good outcome,” Grigoriadis says.
Yonkers hopes these findings will help change the way both doctors and pregnant women view mental illness. In particular, that its treatment needs to stop during gestation.
“One of the things that concerns me is that in many instances, I have the sense that physicians and patients think psychiatric conditions and treatment in pregnancy is optional. It’s not optional. If you have panic disorder, you will suffer if it’s not treated.”
She points to patients who have experienced panic disorder that they’ve mistaken for a heart attack, including chest pain and heart arrhythmia.
“You have to respect the illness and recognize that treatment is not an optional, cosmetic thing.”
There is no “one size fits all” approach to treating psychiatric disorders in pregnancy — each patient needs to be diagnosed and treated individually by her health care professional — and pharmaceuticals are not the only option, she says, pointing to behavioural treatments that can help with anxiety disorders.
“If it’s possible to avail yourself of those, that’s great. But if it’s not sufficient, you have to be treated [with medication].”
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