Benzodiazepine exposure in pregnancy and risk of major malformations: A critical overview

Psychiatric Unit, United Hospitals of Ancona and Department of Experimental and Clinical Medicine at the Polytechnic University of Marche, Ancona, Italy.
General hospital psychiatry (Impact Factor: 2.61). 10/2012; 35(1). DOI: 10.1016/j.genhosppsych.2012.09.003
Source: PubMed


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.

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.

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.

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.

32 Reads
  • Source
    • "A meta-analysis of case control and cohort studies of benzodiazepine use during pregnancy [8] found no increased odds of major malformations in the fetus. Summarizing the few studies available reporting safety of individual benzodiazepines, chlordiazepoxide and diazepam were considered safe, clonazepam and alprazolam were linked to higher risk of major malformation (no specific malformation pattern) and lorazepam was linked to higher risk of anal atresia [9] "
    [Show abstract] [Hide abstract]
    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.
    Full-text · Article · Feb 2015 · General Hospital Psychiatry
  • [Show abstract] [Hide abstract]
    ABSTRACT: Women with active psychiatric disorders who become pregnant face treatment dilemmas. Although results from studies are inconsistent, small but significant, risks on birth outcomes occur with exposure to untreated disorders, as well as to psychotropic medications. Prenatal antidepressant medication exposure may increase the risk for spontaneous miscarriage, preterm birth, cardiac malformations, persistent pulmonary hypertension of the newborn and postnatal adaptation syndrome. The use of valproate is contraindicated during pregnancy due to teratogenicity and neurocognitive delay and deficits. This review of selected studies will highlight some of the current issues with the use of psychotropic medications during pregnancy and the postpartum period.
    No preview · Article · Nov 2013 · Women s Health
  • [Show abstract] [Hide abstract]
    ABSTRACT: Substance use disorders during pregnancy pose serious risks for both the mother and the fetus, demanding careful monitoring by the patient's medical providers. Sedative-hypnotic use, in particular, is common but remains poorly studied. Management of withdrawal from chronic benzodiazepine use during pregnancy presents unique challenges to the treating physician. We present two pregnant patients with dependence on sedative-hypnotic agents, outline principles of benzodiazepine withdrawal, and suggest guidelines for detoxification during pregnancy.
    No preview · Article · Nov 2013 · Archives of Women s Mental Health
Show more