Anxiety is common during pregnancy and postpartum. Sometimes changes to your lifestyle—introducing more exercise, for instance, or seeing a mental health professional—are enough to manage your anxiety. Sometimes pharmaceutical support in the form of antidepressants, several of which are generally considered safe during pregnancy and lactation, can help. Other times, though, your anxiety feels so unmanageable that you may want to talk to your care provider about medications that are not often recommended during pregnancy. In this post, we’ll walk through the research and evidence for the safety (or not) of anti-anxiety medication during pregnancy and nursing.
In 2008, a committee from the American College of Obstetricians and Gynecologists (ACOG) released recommendations to clinicians caring for pregnant people with anxiety, specifically about the use of psychiatric medications. [1] In their recommendations, the committee suggests that use of one medication at a higher dosage is preferable to taking multiple different drugs. They also explain that “all psychotropic medications cross the placenta, are present in amniotic fluid, and can enter breast milk.”
The most common anxiolytic medications are so-called benzodiazepines, which include Xanax, Klonopin, Ativan, and Valium. Each of these medications are considered risky to use during pregnancy; however, it’s possible that the benefits of treating anxiety outweigh these risks in your individual case, which is something you could talk over with your doctor or midwife.
In a 2002 review paper, three psychiatrists evaluated previously published evidence for and against the use of benzodiazepines during pregnancy and lactation. [2] They recommend that physicians stick to prescribing the benzodiazepines, such as Librium, with long safety records and use the lowest dose that effectively treats symptoms for the shortest possible time. The authors also suggest avoiding taking more than one drug at a time, in agreement with the ACOG guidelines.
One of the main concerns about benzodiazepine use during pregnancy, particularly in the first trimester, is that there has been evidence in the past pointing to a link between taking these drugs in pregnancy and oral clefts or heart defects in babies. In a 2019 meta-analysis (a piece of research that analyzes other research that’s already been done), though, researcher and clinician Sophie Grigoriadis and colleagues did not find a connection between use of benzodiazepines alone during pregnancy and either cardiac or oral malformations. [3] The researchers did find that there may be a higher chance of oral clefts and cardiac defects when benzodiazepine use was combined with the use of antidepressants, specifically serotonin selective reuptake inhibitors (SSRIs). They therefore suggest caution with the combination of SSRIs and benzodiazepines, advice consistent with the ACOG recommendations from 2008.
Another concern that arises with the use of benzodiazepines during both pregnancy and breastfeeding is immediate impact on the baby. Along these lines, a team of researchers in Oslo, Norway, recently looked at outcomes for babies whose mothers used benzodiazepines during pregnancy. [4] In their study, which was published in June 2020 in Jama Network Open, the team studied more than 82,000 pregnancies. They found that benzodiazepine use was associated with a slightly shorter pregnancy (about two days), slightly smaller babies (about two ounces smaller), and a higher risk of preterm birth. Despite these connections, the authors concluded that these results are “not necessarily clinically significant ,” meaning that their use may be appropriate after analysis of the potential risks and benefits.
In terms of breastfeeding, researchers from Hokkaido University in Japan published a study this year (2021) in the journal Breastfeeding Medicine in which they tested the levels of eight benzodiazepines in blood plasma and breast milk and evaluated their breastfeeding infants for abnormal behavior and health. [5] The research team determined that “drug exposure through breast milk is small; thus, maternal drug treatment and breastfeeding are compatible,” which is good news for anyone who’s considering taking benzodiazepines and continuing to nurse an infant. If that’s you, talk to your care provider, lactation consultant, and pediatrician about your options.
- ACOG Committee on Practice Bulletins–Obstetrics. “Use of psychiatric medications during pregnancy and lactation,” Obstet Gynecol,
- Iqbal MM et al., “Effects of commonly used benzodiazepines on the fetus, the neonate, and the nursing infant,” Psychiatr Serv,
- Grigoriadis, S. et al., “Benzodiazepine Use During Pregnancy Alone or in Combination With an Antidepressant and Congenital Malformations: Systematic Review and Meta-Analysis,” The Journal of Clinical Psychiatry, 2019.
- Huitfeldt, A. et al., “Associations of Maternal Use of Benzodiazepines or Benzodiazepine-like Hypnotics During Pregnancy With Immediate Pregnancy Outcomes in Norway,” JAMA Network Open,
- Nishimura, A. et al., “Benzodiazepine Concentrations in the Breast Milk and Plasma of Nursing Mothers: Estimation of Relative Infant Dose.” Breastfeeding medicine: the official journal of the Academy of Breastfeeding Medicine, 2021.
