Anxiety Medication Effects on Fetal Kidney Development

According to the National Institute of Mental Health, 40 million Americans suffer from anxiety disorders in a given year. Treatment poses special concerns for pregnant women. While medication can carry risks, untreated anxiety also carries risk. Yet, while more study is needed, after decades of use by thousands of women there are only a handful of reported cases on the effects of anxiety medication on fetal kidney development.

Effects of Anti-Anxiety Medications

• Benzodiapines (BZD) like valium and atavan, are "anti-anxiety" medications; that is, they are prescribed specifically to treat anxiety. There is very little evidence of adverse effects, despite use since the 1960s. One case of kidney abnormalities found in the fetus of a woman taking the benzodiazepine, chlorazepate (tranxene) was reported in 1980 by doctors D.A. Patel and A.R. Patel in the Journal of the American Medical Association. There is also evidence linking benzodiazepines to low birth weight; and low birth rate may, in turn, lead to developmental problems in the kidneys. But several more recent and comprehensive reviews of evidence published, for example, in the 2004 issue of Pharmacological Review report no connection between fetal kidney development and BZDs. In addition, a study by researchers at Semmelweis University in Budapest, Hungary found no signs of congenital abnormalities in infants born to women on very high doses of the benzodiazepine diazepam (valium). The bulk of research, then, shows no effects on fetal kidney development.

Effects of Anti-Depressants

• SSRIs, "anti-depressants," are now also used widely to treat anxiety disorders. A review of case reports in 2002 by the Food and Drug Administration (FDA) found three cases of kidney abnormalities in the fetuses of women taking celexa (an SSRI anti-depressant sometimes used to treat anxiety), but there was no pattern found in the cases and the FDA issued no warning. The same reviews of the effects of BZD reviewed SSRIs and report no adverse effects on fetal kidney development.

Un-treated Anxiety

• Untreated anxiety can result in lower birth weight, possibly from lower cortisol levels or uterine artery resistance. Panic attacks during pregnancy can cause fetal distress and decreased nutrition. Untreated anxiety and depression (often co-occurring with anxiety) can also lead to lower levels of prenatal care, infant-mother bonding, and the possibility of higher levels of hyperactivity in children up to age nine.

Alternative Treatments

• Psychotherapy ("talk therapy") may be the first choice for treatment in pregnant women with moderate levels of anxiety. Cognitive behavioral therapy, in particular, has clearly demonstrated efficacy for both anxiety and depression. Exercise also has demonstrated effectiveness for treating anxiety in pregnant women, as well as meditation and yoga.

Considerations

• BZD in the third trimester may pose a risk of sedation, withdrawal, and "floppy baby" syndrome. SSRIs have an unclear record in terms of congenital malformation, but appear to have no adverse effects on IQ, or other neurobehavioral functions.