Is it safe to take Xanax during pregnancy?

In this article:

• Xanax and pregnancy
• Potential risks
• Alternatives
• Natural remedies

In this article

• Xanax and pregnancy
• Potential risks
• Alternatives
• Natural remedies

Xanax is the brand name of alprazolam, a type of benzodiazepine used to treat anxiety disorders and panic disorders. It works by increasing a neurotransmitter called GABA, which helps calm down the nervous system. Xanax can lead to dependence and abuse, which is why it’s classified as a Schedule IV federally controlled substance.

If you are pregnant and experience anxiety or panic, you might want to know: Can you take Xanax while pregnant? Most healthcare providers don’t recommend taking Xanax while pregnant because of potential risks and side effects to fetuses and pregnant women. 

Can you take Xanax while pregnant?

Xanax is classified as a category D medication. This means there is some evidence of risk to the fetus if the medication is taken during pregnancy, and that the potential benefits of taking the medication outweigh the risks.

Babies born to mothers taking benzodiazepines like Xanax may experience symptoms of sedation and drug withdrawal. There aren’t definitive studies that show that benzodiazepines cause congenital malformations, but there aren’t studies to rule out this risk either.

Overall, health care providers advise avoiding Xanax during pregnancy due to its potential risks. This is true of Xanax, as well as other benzodiazepines. “All benzodiazepines carry a similar risk, so one is not necessarily better than the other when it comes to safety during pregnancy,” says Adi Davidov, MD, associate chair of gynecology at Northwell’s Staten Island University Hospital.

The use of benzodiazepines like Xanax can be risky at any time during pregnancy, but certain trimesters may carry different risks than others. “The most dangerous time to take benzodiazepines is in the first trimester when the baby’s organs are developing, but it can also be dangerous toward the end of the pregnancy as it can cause neonatal withdrawal syndrome,” Dr. Davidov says. 

What are the risks of taking Xanax while pregnant?

Studies that have looked at the risks of taking Xanax during pregnancy have been mixed, with some studies showing an increased risk of miscarriage and other studies showing less of a risk. Additionally, several studies have found an association between Xanax use and low birth weight for babies.

Though more research is needed, studies overall don’t show increased congenital disorders or fetal deaths when mothers take Xanax during pregnancy. “The data we have is reassuring that birth defect rates are likely not increased with Xanax use,” says Ashley Peterson, MD, maternal-fetal medicine physician and director of the Perinatal Diagnostics Center at Tufts Medical Center.

What is more clear are the risks to infants that can happen after birth. Xanax crosses the placenta, which means that fetuses are exposed to it in utero. “Withdrawal symptoms or sedation can be seen in newborns exposed during pregnancy,” Dr. Peterson says. Additionally, “the baby may also have respiratory depression if the mother is on a high dose of benzodiazepine,” Dr. Davidov explains.

Finally, the use of Xanax can be dangerous, and even life-threatening, for pregnant women. “The long-term use of Xanax in adults, pregnant or not, has a risk for abuse, misuse, and drug dependence, which can lead to overdose and death,” Dr. Peterson notes. “Xanax also has the potential for serious life-threatening side effects for patients when combined with other medications (such as opioids) by causing sedation, respiratory depression, and death.”  Another risk for adults and newborns is life-threatening seizures from the abrupt cessation of Xanax.’

What can I take instead of Xanax during pregnancy? 

While Xanax is generally not the best choice when you’re expecting, if you are experiencing anxiety during pregnancy, you shouldn’t overlook it. Untreated anxiety during pregnancy has its own risks, so you should work with your healthcare provider to find other medications to support you.

“It is important to note that anxiety can be a serious medical condition and the risks of untreated or undertreated anxiety oftentimes are higher than the risks associated with taking a medication like Xanax,” Dr. Davidov says. Healthcare providers “will typically have a conversation with the patient, weigh the risks and benefits, and give the patient a recommendation.”

Most healthcare professionals will recommend other, safer medications before Xanax. “In terms of medications, SSRIs should be the first line of therapy for anxiety, which is generally considered to be safe during pregnancy,” Dr. Davidov says. Examples of pregnancy-safe SSRIs antidepressants include Celexa, Prozac, and Zoloft.

For acute anxiety attacks or episodes, Dr. Davidov says that antihistamines like hydroxyzine or Benadryl (diphenhydramine) are sometimes recommended. Benadryl is a category B, and Hydroxyzine is category C. You should discuss with your health care provider before using any medications while trying to conceive, pregnant, or breastfeeding.

Above all, you should consult with your healthcare provider about your anxiety and mental health and what medications are best for your specific situation. 

Natural remedies for anxiety during pregnancy

Medications aren’t the only option for managing anxiety during pregnancy, and even if you are using medication, it can be helpful to combine medication with lifestyle modifications and other natural remedies.

According to Dr. Davidov and Dr. Peterson, natural treatment options include:

• Cognitive behavioral therapy (CBT)
• Psychotherapy
• Mindfulness exercises
• Meditation
• Acupuncture
• Exercise
• Yoga
• Aromatherapy

In terms of vitamins or supplements, you should be cautious when considering supplements during pregnancy. “The FDA does not approve supplements for safety or efficacy before marketing,” says Dr. Peterson, who adds that supplements can be mislabeled, contaminated, and sometimes lead to dangerous interactions for pregnant mothers.

“Patients should discuss the risks and benefits of any supplements they are considering using with their physician first before doing so,” says Dr. Peterson.

Anxiety during pregnancy should be taken seriously, but it’s also important to understand the risks of taking medications like Xanax while pregnant. During pregnancy, it’s crucial to be in communication with your healthcare provider when it comes to managing your anxiety, as well as any prescription drugs or other remedies you are considering.