Pregnancy and Breastfeeding

[Nicole Pryor]

I’m exclusively breastfeeding a 7 month old and I am 7 weeks pregnant. I started Zoloft (worked up to 100 mg) and Ativan 0.5 mg qhs shortly after the birth of my 7 month old for severe insomnia and anxiety. I stopped taking the Ativan after a couple months due to fear of addiction and I started trazadone 50-100mg to help with my insomnia. After finding out I was pregnant, I talked with my doctor and I stopped taking my medications (wanted to wait until at least the first trimester was over to reasses). I’m struggling with insomnia and occasional anxiety and wondered if there was anything I can take while both breastfeeding and pregnant. I considered trying an antihistamine, but I don’t want to compromise my milk supply. Also, in a couple months I’ll be dealing with extreme allergies for 2-4 weeks. Anything safe I can take during this time?

Thank-you,

Nicole

[Sandra]

Nicole Pryor,

For your allergies you can use regular Claritin (loratadine) or regular Zyrtec (cetirizine) in pregnancy as they are both rated P-2's. Multiple studies have shown no increased risk of congenital anomalies in pregnancy. It is believed to be safe even in early pregnancy.


Visteril (hydroxyzine) does not have a pregnancy rating. "Human data does not consider this drug as a possible teratogen. The data indicates a low risk for teratogenicity. Hydroxyzine is an antihistamine that is most commonly used to treat allergic symptoms.[1] An active metabolite of hydroxyzine is cetirizine. Cetirizine is known for its less sedating effects.[2] Taking hydroxyzine during pregnancy does not seem to increase the risk of congenital malformations .[2] Animal studies done on this drug suggest possible structural anomalies in the fetus.[1] However, human data does not consider this drug as a possible teratogen. A surveillance study found this drug to increase the risk of oral clefts and a case report links it to neonatal withdrawal syndrome. [1, 3] More clinical data needs to become available on the use of this medication in pregnancy. For now, the data indicates a low risk for teratogenicity. This drug should only be used in pregnancy when necessary. (Medications and Mothers' Milk database, Dr Thomas Hale PhD.) Visteril can be used for both anxiety and allergies.

Zoloft is still considered safe in pregnancy, it is rated a P-3. "Studies show that the use of this drug in pregnancy does not increase the risk of congenital malformations.[1, 2] Sertraline is an antidepressant drug belonging to the group of selective serotonin reuptake inhibitors (SSRIs). Studies show that the use of this drug in pregnancy does not increase the risk of congenital malformations.[1,2] Further, this drug has been linked to the development of neonatal abstinence syndrome. It is recommended that infants born to mothers who were on any SSRI during their pregnancy be followed closely for at least 48 hours.[3] This is to ensure that the infant does not develop neurologic symptoms of withdrawal. In a study published in 2009 by the British Medical Journal, it was found that infants of mothers who took an SSRI during pregnancy were at a higher risk of developing septal heart defects.[4] This data has subsequently been refuted and we do not believe that sertraline increases the risk of septal heart defects. A study has shown that if infants are exposed to SSRI prenatally alone or prenatally and postnatally via breast milk have blunted response to pain as compared to control infants.[5] A small prospective study has shown that mothers taking SSRI had a delayed onset of milk secretory activation by an average of 16.7 hours and the breastfeeding rate at 2 weeks postpartum was 27% to 33% lower than mother who didnt take antidepressants. More studies need to be done on this topic." (Medications and Mothers' Milk database, Dr Thomas Hale PhD).

Antihistamines do not decrease the milk supply in most case, we have had a few calls about reduced milk supply with use of benadryl with high doses or prolonged use, but that is the only one.

Visteril:

1.##Briggs G, Freeman R, Yaffe S. A Reference Guide to Fetal and Neonatal Risk: Drugs in Pregnancy and Lactation. Vol 1. Seventh Edition ed. Philadelphia, PA: Lippincott Williams & Williams; 2005.
2.##Einarson A, Bailey B, Jung G, Spizzirri D, Baillie M, Koren G. Prospective controlled study of hydroxyzine and cetirizine in pregnancy. Ann Allergy Asthma Immunol. Feb 1997;78(2):183-186.
3.##Serreau R, Komiha M, Blanc F, Guillot F, Jacqz-Aigrain E. Neonatal seizures associated with maternal hydroxyzine hydrochloride in late pregnancy. Reprod Toxicol. Nov-Dec 2005;20(4):573-574.

Zoloft:

1.##Kulin NA, Pastuszak A, Sage SR, et al. Pregnancy outcome following maternal use of the new selective serotonin reuptake inhibitors: a prospective controlled multicenter study. JAMA. Feb 25 1998;279(8):609-610.
2.##Einarson TR, Einarson A. Newer antidepressants in pregnancy and rates of major malformations: a meta-analysis of prospective comparative studies. Pharmacoepidemiol Drug Saf. Dec 2005;14(12):823-827.
3.##Levinson-Castiel R, Merlob P, Linder N, Sirota L, Klinger G. Neonatal abstinence syndrome after in utero exposure to selective serotonin reuptake inhibitors in term infants. Arch Pediatr Adolesc Med. Feb 2006;160(2):173-176.
4.##Pe

Sandra Lovato R.N.
InfantRisk Center
806-352-2519

[KellyOden]

Hey, this is really sad to know about your anxiety problem. One of my friends was also facing such situation and she started practicing yoga and meditation that helped her get over the problem, you can also try such things.