Benzodiazepine exposure in pregnancy and risk of major malformations: a critical overview
ABSTRACT OBJECTIVE: Benzodiazepines (BDZs) safety profiles in pregnancy suggest that the risk of major malformations (MMs) cannot be considered simply as a "class effect". The aim of this paper was to review and update the available literature on the risks of MMs in women exposed to BDZs in the first trimester of pregnancy. METHODS: PubMed was searched for English-language articles, from January 2001 to November 2011, introducing as keywords "teratogens", " major malformation", "foetus", "infant", "newborn", "pregnancy", in conjunction with "benzodiazepines" as a keyword or BDZ generic name as text words. RESULTS: Twelve studies were selected for the review. BDZ exposure during the first trimester of pregnancy seems not to be associated with an increasing risk of congenital MMs. Diazepam and chlordiazepoxide should be considered drugs of first choice. CONCLUSIONS: Data published in the last 10 years did not indicate an absolute contraindication in prescribing BDZs during the first gestational trimester. In any case, studies analyzed suffer from a number of methodological limitations such as lack of careful report of BDZ patterns of use in pregnancy, possible influences of recall bias, lack of controlling for confounding factors and lack of data concerning possible MMs in aborted fetuses.
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ABSTRACT: Pregnant women are advised to stop drinking alcohol, but there is very little evidence-based guidance on the management of alcohol withdrawal. We describe a case of alcohol withdrawal during pregnancy and summarize available information on treatment. Copyright © 2015 Elsevier Inc. All rights reserved.General Hospital Psychiatry 02/2015; DOI:10.1016/j.genhosppsych.2015.02.001 · 2.90 Impact Factor
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ABSTRACT: AimsTo compare benzodiazepine (BZD) purchases in different groups of mothers of small children.DesignProspective population-based cohort study based on the Finnish social and health care registers.SettingFinnish women of child-bearing age.ParticipantsAll women who gave birth in 2002 in Finland (n = 54 519).MeasurementsLatent class analysis was used to create a typology of mothers according to their substance abuse status, psychiatric disorders and socio-demographic characteristics. The mothers were followed-up yearly for purchases of benzodiazepines, starting four years before the child's birth and continuing up to the child's seventh birthday. BZD purchases in different mother groups were compared using negative binomial hurdle models.FindingsThe five mother types identified by latent class analysis were mothers with substance abuse (1%), mothers with psychiatric disorders (1%), mothers with a risk of social marginalisation (11%), mothers with minor social problems (18%) and mothers with no identified problems (69%; the comparison group). Mothers with substance abuse problems had the highest odds of purchasing BZDs (OR = 23.0, 95% CI 19.3-27.4) and their purchase counts were the highest (RR = 13.9, CI 10.4-18.9). The change in time was similar in all groups: the probability of purchasing and the number of purchases were lowest during pregnancy and the year of the child's birth.Conclusions In Finland, among mothers of young children, prevalence of benzodiazepine use is reduced during pregnancy and the child's first year, and then increases as the child grows older. Mothers with substance abuse and psychiatric disorders are at particularly high risk of benzodiazepine use. This article is protected by copyright. All rights reserved.Addiction 11/2014; 110(4). DOI:10.1111/add.12808 · 4.60 Impact Factor
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ABSTRACT: Psychiatric disorders are equally common during pregnancy as among non-pregnant women, and many of these conditions are treated with psychotropic medicines. Relatively little is known about patterns of use of many these agents during pregnancy, and specifically of how rates may have shifted during the last decade. We aimed to quantify the rate of pregnancy related exposures to categories of psychotropic medicines stratified according to the primary indication for use (antidepressants, antipsychotics, anxiolytics, and psychostimulants), trimester of pregnancy, trends over time and region, and indication for use.BMC Pregnancy and Childbirth 07/2014; 14(1):242. DOI:10.1186/1471-2393-14-242 · 2.15 Impact Factor