Although many women suffer with anxiety disorders during pregnancy, research investigating the impact of anxiety disorders on childbirth outcomes has been limited. Here, Yonkers and colleagues contributed to this knowledge base by analyzing maternal and fetal outcomes in a large cohort of women suffering with generalized anxiety disorder (GAD) or panic disorder during pregnancy. Notably, the authors also considered confounding factors such as treatment of anxiety during pregnancy. It was found that neither GAD nor panic disorder significantly increased the risk of gestational hypertension or preeclampsia, cesarean delivery, preterm birth, low-birth weight, minor neonatal respiratory interventions, or neonatal ventilatory support.

However, psychotropics used to treat anxiety disorders were associated with some, albeit minor, adverse consequences. Specifically, benzodiazepines increased the risk of cesarean delivery, low birth weight, neonatal ventilatory support, and shorter gestational duration (3.6 days shorter); selective serotonin reuptake inhibitors (SSRIs) increased the risk of preterm birth, neonatal respiratory interventions, shorter gestational duration (1.8 days shorter), and hypertension during pregnancy (Figure). Importantly, the authors were careful to consider the possibility that benzodiazepines and SSRIs may be used more frequently in the most severe cases of anxiety; however, these data were not confounded by illness severity.

The decision to treat mental health conditions, such as anxiety disorders, during pregnancy is an important and personal one; the health of the mother must be carefully weighed against potential adverse outcomes to the fetus. This study adds valuable data on which such decisions can be informed.

Both benzodiazepine and selective serotonin reuptake inhibitor (SSRI) use during pregnancy were associated with increased probability of some adverse outcomes for mother and child. For example, use of benzodiazepines during pregnancy is estimated to bring about 200 additional cesarean deliveries per 1000 births and SSRI use during pregnancy is estimated to lead to an additional 53 cases of maternal hypertension per 1000 births.

Reference:

>>Yonkers KA, Gilstad-hayden K, Forray A, Lipkind HS. Association of Panic Disorder, Generalized Anxiety Disorder, and Benzodiazepine Treatment During Pregnancy With Risk of Adverse Birth Outcomes. JAMA Psychiatry. 2017; Epub ahead of print.