Q. I am unexpectedly pregnant with my 2nd child. I am filled with guilt about taking Ativan in my first trimester. I am having (irrational ?) thoughts of gross malformations. In my research, I found there is a higher risk of cleft palate with benzodiazepines in the embryonic stage. I have panic attacks and also worry about the effect of the released chemicals on the fetus. Any information you can give me would be appreciated.

A. Congratulations on the pregnancy. Do not worry about the things you cannot change. The benzodiazepine part is done. If you have panic, you needed to have it treated. Taking lorazepam is probably fairly benign to the fetus. If you want to eliminate benzodiazepines, use one of the newer antidepressants. While the antidepressants are effective in most panic cases, not all cases respond to Zoloft, Prozac, Effexor, or Serzone. These agents seem to be fairly safe in pregnancy, however, and routinely used by obstetricians.

If there were gross congenital anomalies, they will show up through the normal checks your obstetrician will do. These include AFP for spinal maladies and ultrasound for larger structural malformations. Let your doctor know about your concerns, and this will insure proper prenatal care. Chances are pretty good that your baby will be fine.