Managing anxiety, panic attacks, and anxiety-related conditions can be difficult during any phase of life, but especially during pregnancy. Most of what we know about the safety of common drugs used to treat anxiety in expectant moms is observational, rather than based on well-researched evidence and studies.
This holds true for the class of drugs called benzodiazepines, which are often used to treat intermittent anxiety. Benzodiazepines, like Ativan (lorazepam), are sedating drugs that slow down the function of your central nervous system, according to American Addiction Centers. They have a variety of clinical uses, including treatment of insomnia and substance abuse disorders, but they carry a sizable risk—they are potentially addictive, come with a host of possible side effects, can have severe withdrawal effects, and can be easily abused.
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These risks are heightened when applied to pregnant and nursing women, who not only have to worry about their own health but the health of their babies. Here’s what you should know about taking Ativan during pregnancy or while breastfeeding.
Is Ativan safe to take while pregnant?
Per the U.S. Food and Drug Administration (FDA), Ativan and generic lorazepam is a pregnancy category D drug, which means it carries known risks to pregnant women or their babies and should be avoided during pregnancy. That doesn’t mean the drug never has applications during pregnancy, but that serious considerations should be made between an expectant mother and her provider before taking it.
“There are drugs that are sometimes used in pregnancy that fall into the D category because they’re necessities for a condition that a woman has,” says Felice Gersh, MD, an OB-GYN and director of the Integrative Medical Group of Irvine in Irvine, California. “You have to ask what would happen if this drug wasn’t used, or what will happen if a woman is already on it [and stops taking it]?”
The mental health of an expectant mother is hugely important to the health of her baby; however, Ativan comes with some documented risks to both mother and child.
- Some studies have found that taking Ativan (lorazepam) while pregnant can lead to preterm labor and low birth weight in infants, according to Sherry Ross, MD, an OB-GYN and women’s health expert at Providence Saint John’s Health Center in Santa Monica, California. A 2009 study published in the American Journal of Obstetrics and Gynecology found that benzodiazepines increased a woman’s chances of preterm labor and poor perinatal outcomes, including low birth weight and low Apgar scores.
- Taking Ativan in the first trimester has been associated with a slight increase in birth defects, including cleft lip and cleft palate, says Dr. Gersh. (The risk is small but does appear to exist.)
- Infants whose mothers used Ativan during pregnancy have a higher risk of neurological impairments. “[Ativan use can] cause floppy infant syndrome, which includes apnea, feeding difficulties, hypothermia, muscle weakness, tremors, jitteriness, respiratory depression, and impaired metabolic response to cold stress,” Dr. Ross says. This may result in a complicated newborn period, including possible intensive care stays for infants.
- Taking Ativan consistently throughout pregnancy or in the later stages of pregnancy can cause addiction and dependence in expectant mothers and even lead to symptoms of withdrawal in newborns after birth.
As with many category D drugs, women trying to conceive or planning to become pregnant often wonder if Ativan can cause infertility or miscarriage. Dr. Ross says there is an increased risk of miscarriage with Ativan use; a 2019 study in JAMA Psychiatry confirms an association between benzodiazepine use and miscarriage, but there are complicating factors (like the insomnia and anxiety the drugs are being used to treat in the first place).
While there’s no evidence that taking Ativan can make it harder to become pregnant, it may still be best to avoid it if you’re hoping to become pregnant soon. And there are certainly safer, more effective medications to take for anxiety during pregnancy.
“Currently there are no studies showing that Ativan can make it more difficult to get pregnant, [but] it’s always best to minimize drugs that could be potentially harmful while trying to conceive,” Dr. Ross explains.
How much Ativan or lorazepam can you take during pregnancy?
Generally speaking, Ativan should be avoided completely during the first trimester, says Dr. Ross, because fetal development is progressing quickly at this stage and the risk of birth defects is higher. Taking it during the second or third trimester should be done under consultation with an experienced provider (psychiatrist with expertise in pregnancy or OB/GYN) to evaluate the risks and benefits. Ideally, once you know you are pregnant, you should work with a provider to determine the safest, most effective treatment for anxiety or panic disorder.
“If the benefits of using this medication outweighs the risks, then it’s best to use it at the lowest dose [for] maximum effect,” says Dr. Ross, who adds that it’s best not to take Ativan for more than two weeks at a time.
What should I do if I’m taking Ativan and suddenly become pregnant?
Although Ativan isn’t safe during pregnancy, you shouldn’t abruptly stop taking it if you find out that you’re expecting. Depending on how much you have been taking or how long you have been using Ativan, you may have developed a dependence on it—and stopping cold turkey could cause serious withdrawal symptoms including seizures.
Instead, advises Dr. Ross, call your provider as soon as you find out you’re pregnant to develop a plan for safely discontinuing your Ativan (lorazepam) use. “It’s best to wean off slowly and with medical supervision…cutting back on the frequency and dose slowly is the safest way to taper off this [risky] medication so withdrawal symptoms don’t develop,” she says.
Is Ativan safe to take while breastfeeding?
Many drugs considered unsafe to use during pregnancy may end up being safe to use while breastfeeding, but Ativan’s safety profile doesn’t change. While we don’t have specific information about the connection between Ativan and breastfeeding, Dr. Gersh says the drug definitely passes to the baby through breast milk and can affect your baby’s alertness.
“Ativan suppresses brain function and a baby’s brain is developing rapidly [at this stage],” Dr. Gersh explains. “We know that frequent use of benzodiazepines in adults can lead to problems with cognition—the last thing you want to do is inhibit brain function of your baby.”
In addition to interfering with brain function, Dr. Gersh says the relaxing properties of benzodiazepines like Ativan can inhibit a baby’s ability to suck or feed properly, which could lead to malnutrition. Failure to breastfeed, combined with cognitive side effects, could also interfere with the mother-child bonding process in the newborn phase. Infants exposed to benzodiazepines can also be excessively irritable.
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How can I safely manage my anxiety while pregnant and breastfeeding?
If you’re living with anxiety while pregnant or postpartum, don’t let the warnings about Ativan scare you away from getting help; while there are no sedatives or benzodiazepines considered safe for use during pregnancy, there are other safer classes of drugs that can be used to treat your symptoms.
In fact, Dr. Gersh says that many doctors are moving away from using Ativan and other sedatives to treat chronic anxiety issues in all patients, pregnant or not. In general, these drugs are not an optimal choice for treatment of chronic anxiety thanks to their high risk of dependency and addiction, a risk that increases with ongoing use. The American College of Obstetricians and Gynecologists (ACOG) recommends that therapy for depression or anxiety during pregnancy be individualized; treatment should incorporate the clinical expertise of the mental health clinician, obstetrician, primary healthcare provider, and pediatrician.
So what does this mean for pregnant or breastfeeding patients with anxiety?
- You should consider receiving therapy from a qualified mental health professional with expertise in pregnancy care. Many anxiety disorders can be managed through cognitive behavioral therapy and mindfulness practices, which a professional can help you with.
- If medication is needed during pregnancy, your doctor can talk to you about pregnancy-safe options. According to Massachusetts General Hospital, Prozac (fluoxetine), selective serotonin reuptake inhibitors, and many tricyclic antidepressants are often considered safe for use during pregnancy. However, tricyclic antidepressants may not be the preferred therapy for depression while pregnant.
- If medication is needed postpartum, while breastfeeding, there are even less restrictions. Zoloft is generally considered the safest anti-anxiety medication to use while nursing, primarily because doctors know the most about its use during breastfeeding. But many antidepressants, including SSRIs, are regarded as safe to take while breastfeeding.
Work with your healthcare provider to find the best treatments option for you.