Xanax and Birth Defects

The use of medications, even over-the-counter drugs, during pregnancy is strongly discouraged by many health experts. Most substances ingested by the mother cross the placenta and enter the fetus unchanged, where their ultimate effects are impossible to predict. For that reason, doctors will generally only prescribe medicine to a pregnant mother when the benefits clearly outweigh the risks. Studies with rats have demonstrated various risk levels to the fetus for different drugs and different dosages. A drug that is known or strongly suspected to cause defects in the unborn fetus is said to have a teratogenic effect. All members of the class of drugs known as benzodiazepines have been labeled as teratogenetic.

The U.S. Food and Drug Administration places all drugs into a “pregnancy category” according to their potential risk to the fetus. The first trimester of pregnancy is always the most vulnerable, as the fetus is still in the early stages of development. Xanax (alprazolam) is a member of Category D, which indicates “positive evidence of human fetal risk.” Only one category—X—indicates a more pronounced risk. However, for certain health conditions in the mother, the benefits may override the inherent risks, even for a Category D medication like Xanax.

A Hungarian study of mothers who attempted suicide with Xanax reveals that the model for teratogenicity is likely more complicated than we thought. Admittedly, the sample size of this study was very small. Only 10 children were born to mothers who attempted suicide with Xanax. One of these children had a serious birth defect that may have resulted from exposure to a single large dose of Xanax. Compared to siblings who were not exposed to this drug during pregnancy, these children had a slightly higher average birth weight. Experts cannot adequately explain that finding, so further research is needed. In terms of cognitive or behavioral abnormalities, the Xanax-exposed children showed no significant differences from their unexposed siblings. An important caveat is that mothers who attempted suicide during pregnancy were very likely to also be underprivileged, smokers, drinkers, and recreational drug users. These hazardous lifestyles may well mask any effect from the overdose of Xanax.

The wisest course of action is to avoid all drugs during pregnancy. Pregnant women should stop smoking and refrain from drinking alcohol. If a woman develops a cold or the flu during pregnancy, she should allow her body to rest and fight off the infection naturally. Assuming her nutrition is adequate and her lifestyle is healthy, this shouldn’t pose a problem. For the most severe cases of panic disorder or a similar anxiety condition, the doctor may still prescribe Xanax. However, this medication should not be considered completely safe for a fetus, especially not during the first trimester.


  1. Gidai, J., Acs, N., Banhidy, F., Czeizel, A. E. (2008). An evaluation of data for 10 children born to mothers who attempted suicide by taking large doses of alprazolam during pregnancy. Toxicology and Industrial Health, 24, 53-60.
  2. Womenshealth.gov. (n.d.). Pregnancy and medicines fact sheet. Retrieved February 28, 2012, from: http://www.womenshealth.gov/publications/our-publications/fact-sheet/pregnancy-medicines.cfm


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