Is Xanax safe during pregnancy?

What does the evidence say about Xanax during pregnancy?

1. Most studies of first-trimester alprazolam have not reported an increased chance of birth defects, and an increased chance has not been proven overall. 1
2. Newborns exposed to a benzodiazepine near delivery can have temporary trouble regulating body temperature, breathing difficulty, low energy, poor feeding, or vomiting, and stopping alprazolam suddenly can cause seizures and rebound anxiety in the person taking it. 1
3. Physical dependence can develop when a benzodiazepine is taken steadily for several days to weeks even exactly as prescribed, and stopping abruptly or cutting the dose too fast can cause withdrawal reactions including life-threatening seizures. 2
4. Prenatal benzodiazepine exposure was not associated with congenital malformations across eight cohort studies, with an odds ratio of 1.13, though combining a benzodiazepine with an antidepressant carried a higher malformation risk at an odds ratio of 1.40. 3
5. Average birth weight and gestational age were not reduced across 48 alprazolam-exposed pregnancies in Western Australia, but those newborns were more likely to be small for gestational age, and no cases of perinatal death or floppy infant syndrome occurred. 4

Is Xanax safe in each trimester?

• First trimester. Most first-trimester studies have not reported extra birth defects with alprazolam, and a meta-analysis of eight cohort studies found no overall increase in congenital malformations. Two prescription-record studies hinted at heart defects, but that association has not been confirmed, and MotherToBaby describes the question as unproven rather than settled.
• Second trimester. Some studies have suggested a higher chance of preterm delivery and low birth weight with alprazolam, while others have not. If you take it regularly, this is a reasonable window to plan any dose change with your prescriber, because a gradual, supervised reduction is the only safe route down.
• Third trimester. Babies exposed to a benzodiazepine near delivery can have trouble regulating temperature, breathing difficulty, low energy, poor feeding, or vomiting. One Australian cohort also found higher odds of being small for gestational age. Your delivery team should know exactly what you take and at what dose.