A pregnant woman’s psychiatric health presents no threat to the health of her baby although using medications to treat common psychiatric conditions during pregnancy may increase complications, according to a new study by researchers at the Yale School of Medicine.
The researchers found that neither panic disorder nor generalized anxiety disorder in mothers is associated with complications such as preterm birth, Cesarean delivery and neonatal ventilator support. Published on Sept. 13 in the journal JAMA Psychiatry, the study was one of the first to investigate the relation between common anxiety disorders and these maternal and neonatal complications, and to quantify the effects of the medications independent of the disorders.
“Women with these psychiatric conditions should not feel guilty that their illness is harming their baby,” said lead author Kimberly Yonkers, a professor at the Yale schools of Medicine and Public Health and the director of Yale’s Center for Wellbeing of Women and Mothers. “If they are symptomatic and need medication treatment, it is reasonable to discuss it with their doctors.”
Heather Lipkind, a medical school professor and the senior author of the study, noted that pregnant women often express concern about how their medications might affect their pregnancies. This concern is exacerbated in pregnant women, who suffer from panic disorders, Yonkers explained. She added that her research is crucial to demonstrating that such conditions will not adversely affect these women’s babies.
Yonkers also said that there has previously been controversy about whether adverse birth outcomes are related to a mother’s illness or her treatment. According to the study, prior investigations may have failed to consider other factors, such as maternal substance use.
The study concluded that there was no increased risk associated with maternal panic disorder or generalized anxiety disorder for adverse maternal or neonatal health outcomes, Yonkers said.
There were, however, mild negative effects associated with maternal use of benzodiazepines and serotonin reuptake inhibitors — two commonly prescribed drugs to treat anxiety, panic disorder and depression.
These adverse outcomes included a small increase in Cesarean deliveries, the need for breathing support for the newborn child and a slightly shorter length of pregnancy, as well as high blood pressure in the mother.
Maternal benzodiazepine treatment resulted in neonatal ventilator support in an additional 61 of 1,000 cases. And the use of serotonin reuptake inhibitors shortened the duration of pregnancy by 1.8 days.
Still, the researchers said these results should not deter pregnant women from receiving treatment.
“Although the uses of these medications are not risk-free, the risks are low,” Lipkind said. “Women who need treatment for these disorders may want to continue medication use.”
The study explained that relapse may occur if patients stop taking medication too early. Furthermore, treatment is necessary in some cases for the mother to carry the pregnancy to term.
The study authors emphasized that they hope these findings will encourage pregnant women to continue receiving treatment during their pregnancies and to discuss with their physicians their optimal dosage levels.
The study followed 2,654 women in pregnancy and into the first eight weeks after delivery. Of these women, 98 had panic disorder and 252 had generalized anxiety disorder, while 67 were treated with a benzodiazepine and 293 were treated with a serotonin reuptake inhibitor during pregnancy.
The researchers used the World Mental Health Composite International Diagnostic Interview to determine psychiatric diagnoses and also interviewed the patients to determine their use of medicated treatments, substance use habits and previous adverse birth outcomes.
During pregnancy, up to 5 percent of women have panic disorder and up to 10 percent have generalized anxiety disorder, according to the study.
Amy Xiong | amy.xiong@yale.edu