Anxiety Disorders (not including PTSD)
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Women have higher rates of panic disorder and general anxiety disorder than men.
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Risk of untreated anxiety during pregnancy include increase of fetal exposure to cortisol (stress hormone) which may cause vasoconstriction and affect maternal blood flow of oxygen and nutrients to fetus; increased risks of postpartum depression and increased risk of neonatal irritability and decreased activity.
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Benzodiazepines – risk benefit counseling is key:
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Labeled by the US FDA as increasing risk for congenital malformations.
Inconsistent findings of congenital malformations with first trimester exposure.
- During late pregnancy, benzodiazepine use can increase neonatal sedation, low tone, and cyanosis.
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When possible, avoid during first trimester and avoid polypharmacy.
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Selective serotonin reuptake inhibitors (SSRIs) have more study data about the relative risks of use during pregnancy than most other medicines. Absolute risks of malformations with SSRI exposure in pregnancy are small.
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Paroxetine use during the first trimester is associated with about a 2-fold increased risk for cardiac malformations (e.g. ventricular septal defects, right ventricular outflow tract obstruction).
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Neonatal withdrawal syndrome can occur – usually mild and easy to manage.
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