While we have focused a great deal on the emergence of mood disorders during pregnancy and the postpartum period, there is a growing body of literature that indicates that anxiety symptoms are prevalent during this period of time and may also affect pregnancy outcomes. Although many women with panic disorder attempt to discontinue their medications during pregnancy, we see high rates of relapse in this population. Understandably women focus primarily on the reproductive safety of medications, but we must also consider the impact of untreated anxiety on the mother and her baby.
In a recent prospective study Uguz and colleagues compared neonatal outcomes, including gestational age, birth weight and hospital admission of newborns, in pregnant women with panic disorder treated with antidepressants to women with untreated panic disorder.
The study included 146 pregnant women (44 with panic disorder treated with antidepressants, 52 with untreated panic disorder, and 50 healthy controls without psychiatric illness) recruited during pregnancy. The diagnosis of panic disorder was confirmed using the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Women were excluded if they had a major medical illness or pregnancy-related complications, use of alcohol and/or tobacco, or use of psychotropic medications other than antidepressants. They also excluded women with comorbid depression or other anxiety disorders.
The authors noted that there were no significant differences among the three groups with regard to age, marital status, education level, employment status, socioeconomic status, gender of the baby, number of children, or mode of delivery.
Worse outcomes were observed in women with untreated panic disorder. Women with untreated panic disorder were more likely to have pregnancies complicated by preterm birth (28.8%), low birth weight (34.6%) and hospitalization in the neonatal care unit (25.0%). Compared to infants of healthy subjects and women receiving antidepressant treatment, infants of untreated mothers had significantly lower birth weight and gestational age at delivery.
In contrast, the neonatal outcomes in women with panic disorder treated with antidepressants were similar to those observed in the control group of women with no psychiatric illness.
This study suggests that the treatment of panic disorder with antidepressants during pregnancy may actually lower the risk of adverse neonatal outcomes. One of the strengths of this study was that the researchers were able to accession three groups of women who were very similar across a number of variables which may affect outcomes, including age, socioeconomic status, education level, smoking, use of alcohol, and exposure to other medications. In other studies assessing the impact of pharmacotherapy on outcomes, treated patients are often different from untreated patients and healthy controls across many of these variables, and we often struggle to account for these differences when interpreting the data.
While we can conclude that treatment of panic disorder with antidepressants improves pregnancy outcomes because the treated women appear to do better than the women who do not receive treatment, we must be aware of other variables that may differ between treated and untreated women as they may affect outcomes. These variables – including physical activity, diet, exposure to psychosocial stressors, quality of prenatal care — are much more difficult to assess yet may be operating in the background.
The Bottom Line
This study provides important and reassuring information for patients and their providers regarding the treatment of panic disorder during pregnancy.
Women with panic disorder treated with antidepressants have similar outcomes to healthy controls with no psychiatric illness with regard to gestational age, risk for preterm delivery, birth weight, and admission to the neonatal care unit. In contrast, women with untreated panic disorder have worse outcomes than both the women with treated panic disorder and the healthy controls.
Ruta Nonacs, MD PhD
Neonatal outcomes in pregnant women with untreated and treated panic disorder.
Uguz F, Yuksel G, Onur OS, Karsidag C, Gezginc K, Arpaci N. Compr Psychiatry. 2018 Oct 9;87:107-111.