Anxiety disorder during pregnancy was associated with poorer pregnancy outcomes, whether or not it was treated with medication, according to a study recently published in the International Journal of Gynecology & Obstetrics.
Researchers reviewed deliveries recorded at a single medical center in Israel between 2013 and 2024, including a total of 142,028 singleton pregnancies (pregnancies with one baby). Most of the women—96.2%—had no anxiety, while 0.7% had a documented anxiety diagnosis but took no medication for it and 3.2% were prescribed medication.
The drugs identified included selective serotonin reuptake inhibitors, or SSRIs (sertraline, escitalopram, fluoxetine, paroxetine, citalopram); serotonin-norepinephrine reuptake inhibitors, or SNRIs (venlafaxine, duloxetine); benzodiazepines (alprazolam, lorazepam, diazepam, clonazepam, oxazepam); and other anti-anxiety medicines (pregabalin, buspirone, hydroxyzine).
It is already known that SSRIs and SNRIs cross the placenta and may affect fetal development. Benzodiazepines build up in fetal tissue and have been linked to higher risks of preterm birth (before 37 weeks), low birth weight, low Apgar scores, and admission to the neonatal intensive care unitNeonatal intensive care unit A specialized hospital unit for newborns who need close monitoring and treatments such as platelet transfusions. (NICUNeonatal intensive care unit A specialized hospital unit for newborns who need close monitoring and treatments such as platelet transfusions.). Because the anxiety itself may cause similar effects, the researchers set out to separate the effect of the anxiety disorder from the effect of the medications used to treat it.
The study found that both groups of women with anxiety, treated and untreated, had a higher risk of a combined measure of birth complications (preterm birth, a low Apgar score, or NICU admission) than women without anxiety. Those complications occurred in roughly 5% of women with no anxiety, 9% of those with untreated anxiety, and 8.7% of those taking medication.
When the researchers compared medicated and unmedicated women directly, however, they found no significant difference between the two groups. That pattern suggests the anxiety condition itself, rather than the medication, may drive the added risk. Preeclampsia (a serious blood-pressure complication of pregnancy), which the study looked at as a secondary maternal outcome, was the one exception: treated women had lower odds of it than untreated women.
Still, the authors noted that the results “should not be interpreted as evidence regarding the safety or causal effects” of medication. Because the records did not capture how severe each woman’s anxiety was, when treatment began, or whether women actually took their prescriptions, the study cannot explicitly separate the effect of the medication from the effect of the anxiety itself. What it does highlight, the researchers said, is a growing trend: anti-anxiety prescribing during pregnancy nearly doubled over the study period, rising from 2.25% of deliveries in 2013 to 4.13% in 2024. They called for further research that measures anxiety severity directly.
Anxiety is common in high-risk pregnancies, including those affected by fetal and neonatal alloimmune thrombocytopenia (FNAIT).
Read more about practical tips for managing anxiety and stress with FNAIT.
