Pregabalin and pregnancy

Dear Dr. Roach • I’m 13 weeks pregnant, and I am on pregabalin (prescribed off-label for anxiety). I asked my GP if it is safe to continue to be on it while pregnant, and he was very dismissive and hurried me out the door without really telling me anything. I read about a very small study that was conducted that seemed to show a risk of birth defects, but due to its small size, it didn’t really help me either. I was wondering if you know anything about pregabalin and pregnancy. — G.H.

Answer • While I understand the demands of a busy practice, your physician should have found time to talk to you about this important issue.

A study from Boston in 2017 looked at a large database and found no statistically significant increase in major congenital abnormalities in women taking pregabalin during pregnancy, but it could not exclude the possibility of a small risk of a harmful effect. Anxiety itself isn’t good for the baby, so the best option would be treatment that is effective but at lowest risk.

In your case, given the large number of medicines for anxiety that are better studied in pregnancy, I would talk to your doctor about a different choice during pregnancy. Benzodiazepines (including Valium, Ativan and others) are seldom my first choice for anxiety, but they are the first choice among many experts in treating anxiety during pregnancy.

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