Is hydroxyzine safe during pregnancy?

What does the evidence say about hydroxyzine during pregnancy?

1. No increase in birth defects was reported in studies involving over 200 people who used hydroxyzine throughout pregnancy, and one study of 100 users found no increased chance of miscarriage. 1
2. Two cases of newborn withdrawal have been reported after hydroxyzine use in the four weeks before delivery, one involving a single seizure and one involving jitteriness, jerking movements, and feeding problems. 1
3. Live birth rates, pregnancy loss, major and minor anomalies, mean birth weight, gestational age, and newborn distress showed no significant differences in a prospective controlled study of 53 pregnancies exposed to hydroxyzine during organogenesis. 2
4. Anxiety disorders are the most common type of mental health condition, affecting nearly 1 in 5 adults including those who are pregnant or postpartum, and any anxiety medication you take belongs on your ob-gyn's list. 3
5. Generalized anxiety disorder affects roughly 9 to 11 out of every 100 pregnant people, and talk therapy, relaxation techniques, and mindfulness can help with mild to moderate symptoms. 4

Is hydroxyzine safe in each trimester?

• First trimester. Studies involving over 200 people who used hydroxyzine throughout pregnancy reported no increase in birth defects, and a prospective study of 53 first-trimester exposures found no difference in major or minor anomalies. Those are small numbers, so first-trimester use tends to be a considered choice rather than a default.
• Second trimester. Hydroxyzine is usually taken as needed rather than daily, which keeps total exposure low. Whether hydroxyzine on its own affects preterm delivery or birth weight is not known. If you find yourself reaching for it most nights, that pattern is worth naming out loud rather than continuing quietly.
• Third trimester. Two cases of newborn withdrawal have been reported after hydroxyzine use in the four weeks before delivery, one involving a single seizure and one involving jitteriness, jerking movements, and feeding problems. Ask your provider specifically about late-pregnancy use and what your delivery team should watch for.