Are exposure-based cognitive behavioral therapies safe during pregnancy?

Anxiety disorders during pregnancy are highly prevalent and associated with serious and enduring consequences for both mother
and child. Exposure-based cognitive behavioral (CBT) and behavioral therapies (BT) represent the most empirically supported
psychosocial treatments for anxiety disorders in general adult samples. Pregnant women, however, generally have been excluded
from this body of research. Evidence that pregnant women inhabit a unique biological context combined with untested assumptions
that exposure would unduly stress or harm the fetus have likely prohibited inquiry. This paper seeks to remedy this gap by
integrating findings from obstetric, psychiatric, and psychological research to inform central questions regarding exposure-based
treatment of anxiety disorders during pregnancy. Based on available evidence, we consider the potential risks and benefits
of CBT/BT for anxiety disorders during pregnancy relative to other currently available treatment options. From a multidisciplinary
research perspective, we argue that exposure-based therapies are likely to be safe during pregnancy, particularly relative
to the alternatives. However, we also highlight critical questions for future research to directly test the biopsychological
impact of exposure-based therapies among pregnant women.