First Trimester Exposure to Anxiolytic and Hypnotic Drugs and the Risks of Major Congenital Anomalies: A United Kingdom Population-Based Cohort Study

Abstract

BackgroundDespite their widespread use the effects of taking benzodiazepines and non-benzodiazepine hypnotics during pregnancy on the risk of major congenital anomaly (MCA) are uncertain. The objectives were to estimate absolute and relative risks of MCAs in children exposed to specific anxiolytic and hypnotic drugs taken in the first trimester of pregnancy, compared with children of mothers with depression and/or anxiety but not treated with medication and children of mothers without diagnosed mental illness during pregnancy.MethodsWe identified singleton children born to women aged 15–45 years between 1990 and 2010 from a large United Kingdom primary care database. We calculated absolute risks of MCAs for children with first trimester exposures of different anxiolytic and hypnotic drugs and used logistic regression with a generalised estimating equation to compare risks adjusted for year of childbirth, maternal age, smoking, body mass index, and socioeconomic status.ResultsOverall MCA prevalence was 2.7% in 1,159 children of mothers prescribed diazepam, 2.9% in 379 children with temazepam, 2.5% in 406 children with zopiclone, and 2.7% in 19,193 children whose mothers had diagnosed depression and/or anxiety but no first trimester drug exposures. When compared with 2.7% in 351,785 children with no diagnosed depression/anxiety nor medication use, the adjusted odds ratios were 1.02 (99% confidence interval 0.63–1.64) for diazepam, 1.07 (0.49–2.37) for temazepam, 0.96 (0.42–2.20) for zopiclone and 1.27 (0.43–3.75) for other anxiolytic/hypnotic drugs and 1.01 (0.90–1.14) for un-medicated depression/anxiety. Risks of system-specific MCAs were generally similar in children exposed and not exposed to such medications.ConclusionsWe found no evidence for an increase in MCAs in children exposed to benzodiazepines and non-benzodiazepine hypnotics in the first trimester of pregnancy. These findings suggest that prescription of these drugs during early pregnancy may be safe in terms of MCA risk, but findings from other studies are required before safety can be confirmed.

Use of benzodiazepine medications during pregnancy and potential risk for birth defects, National Birth Defects Prevention Study, 1997–2011

“…We did observe a statistically increased OR for pulmonary valve stenosis for mothers who reported lorazepam use. Data from a UK cohort showed no association between maternal first trimester prescriptions for diazepam and the broad categories of any birth defect, heart defects, limb defects, or genital system defects (Ban et al, ).…”

Does maternal somatic anxiety in pregnancy predispose children to hyperactivity?

“…This has implications for the treatment of anxiety during pregnancy. A large nationwide prescription study did not find an increase in congenital malformations in children of women exposed to anxiolytic drugs compared to non-exposed women [42]; this knowledge should facilitate pharmacological treatment of these symptoms in a clinical setting. Several psychological interventions have been evaluated to improve maternal wellbeing during pregnancy.…”

Alcohol, smoking, and other substance use in the perinatal period

“…Evidence is conflicting regarding short and long term impacts of benzodiazepines on the developing infant 50515253. “Floppy baby syndrome” (including poor muscle tone, hypothermia, lethargy, and breathing and feeding difficulties) has been reported in neonates exposed to benzodiazepines in utero.…”