Prevalence of benzodiazepines and benzodiazepine-related drugs exposure before, during and after pregnancy: A systematic review and meta-analysis

Bais, Babette; Molenaar, Nina M.; Bijma, Hilmar H.; Hoogendijk, Witte J.G.; Mulder, Cornelis L.; Luik, Annemarie I.; Berg, Mijke P. Lambregtse–van den; Kamperman, Astrid M.

doi:10.1016/j.jad.2020.03.014

Cited by 58 publications

(39 citation statements)

References 63 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…For most of the countries included in this work, no antidepressant utilization data postpartum are available. Sertraline, paroxetine, citalopram [34] NS BZD: 1.1 [25,35] AP: NA Quetiapine: NA AD = antidepressant; BZD = benzodiazepines; AP = antipsychotics; SAH = sedative antihistamines; PMH-S = peripartum mental health-specific; N-PPD = not specific to peripartum depression, but pregnant women are dealt with within the guideline for adult depression. Estimates of sedative antihistamines are only shown when available.…”

Section: Pharmacological Interventions For Treatment Of Postpartum De...mentioning

confidence: 99%

Treatment of Peripartum Depression with Antidepressants and Other Psychotropic Medications: A Synthesis of Clinical Practice Guidelines in Europe

Kittel‐Schneider

Felice

Buhagiar

et al. 2022

IJERPH

View full text Add to dashboard Cite

This study examined (1) the availability and content of national CPGs for treatment of peripartum depression, including comorbid anxiety, with antidepressants and other psychotropics across Europe and (2) antidepressant and other psychotropic utilization data as an indicator of prescribers’ compliance to the guidelines. We conducted a search using Medline and the Guidelines International Network database, combined with direct e-mail contact with national Riseup-PPD COST ACTION members and researchers within psychiatry. Of the 48 European countries examined, we screened 41 records and included 14 of them for full-text evaluation. After exclusion of ineligible and duplicate records, we included 12 CPGs. Multiple CPGs recommend antidepressant initiation or continuation based on maternal disease severity, non-response to first-line non-pharmacological interventions, and after risk-benefit assessment. Advice on treatment of comorbid anxiety is largely missing or unspecific. Antidepressant dispensing data suggest general prescribers’ compliance with the preferred substances of the CPG, although country-specific differences were noted. To conclude, there is an urgent need for harmonized, up-to-date CPGs for pharmacological management of peripartum depression and comorbid anxiety in Europe. The recommendations need to be informed by the latest available evidence so that healthcare providers and women can make informed, evidence-based decisions about treatment choices.

show abstract

Section: Pharmacological Interventions For Treatment Of Postpartum De...mentioning

confidence: 99%

Treatment of Peripartum Depression with Antidepressants and Other Psychotropic Medications: A Synthesis of Clinical Practice Guidelines in Europe

Kittel‐Schneider

Felice

Buhagiar

et al. 2022

IJERPH

View full text Add to dashboard Cite

show abstract

“…Furthermore, Källén et al (2013) reported that exposure during pregnancy to alprazolam, a derivative of benzodiazepines, was associated with a 1.97-fold increased risk of congenital malformations. Despite these risks, some pregnant women still need to take alprazolam to avoid the harmful effects of mental illness on maintaining pregnancy ( Bais et al, 2020 ). According to American College of Obstetricians and Gynecologists (ACOG) guidelines ( Armstrong, 2008 ), it is recommended to prescribe alprazolam (benzodiazepines) to those with psychiatric illness during pregnancy after considering its risks versus benefits.…”

Section: Introductionmentioning

confidence: 99%

Pregnancy and Neonatal Outcomes After Exposure to Alprazolam in Pregnancy

et al. 2022

View full text Add to dashboard Cite

Alprazolam is a commonly prescribed benzodiazepine for anxiety or panic disorder, even in pregnant women. Information on the safety of alprazolam during pregnancy is insufficient. We aimed to evaluate pregnancy and neonatal outcomes after exposure to alprazolam during pregnancy. A prospective study was conducted on 725 pregnancies from January 2000 to December 2019. Participants were recruited through the Korean Mother-Safe Program, a service providing information on drug-induced teratogenic risk during pregnancy and breastfeeding. Exposed (N = 96) and non-exposed (N = 629) women to alprazolam during pregnancy were selected and followed-up until delivery. Pregnancy outcomes, including spontaneous abortion, still birth, low birth weight (LBW), preterm birth, Apgar score (at 1 and 5 min), and malformations were measured and compared. Multivariable logistic regression was performed to examine the association between alprazolam exposure and outcomes. The mean age was 32.9 (SD 4.0) years in the alprazolam-exposed group and 31.8 (SD 3.8) years in the unexposed group (p = 0.008). The alprazolam exposure group demonstrated a significantly higher likelihood of pregnancy and neonatal outcomes: spontaneous abortion (OR = 2.38; 95% CI 1.20–4.69), LBW (OR = 3.65; 95% CI 1.22–11.00), and Apgar score at 1 min ≤ 7 (OR = 2.19; 95% CI 1.02–4.67). There was no significant difference in congenital abnormalities between the exposure and non-exposure groups. Our findings confirmed that alprazolam exposure during pregnancy was significantly associated with adverse pregnancy and neonatal outcomes, including spontaneous abortion, low birth weight, and Apgar score at 1 min ≤ 7. Alprazolam during pregnancy should be appropriately regulated and monitored.

show abstract

“…25 When used during pregnancy, benzodiazepines and benzodiazepine-related drugs pass readily through the placenta, and are associated with adverse birth outcomes (spontaneous abortion, preterm birth, and when used in the third semester loppy infant syndrome or respiratory problems). 25 Many studies have shown that the use of antidepressants decreases during the first 3 months of pregnancy. [26][27][28][29][30] A recent population-based study from Denmark, observed that the prescription of antidepressants was less common during pregnancy than before and after it in the period 1997 to 2016.…”

Section: And the 2018 International Cochrane Reviewmentioning

confidence: 99%

“…In France in 2016, 5% of women were exposed to at least one anxiolytic–hypnotic drug during pregnancy 23 . Benzodiazepines are often prescribed for anxiety and depression, 24 with substantial heterogeneity across countries, and across the different periods of pregnancy (e.g., increase from preconception to pregnancy, with a subsequent decrease to postpartum) 25 . When used during pregnancy, benzodiazepines and benzodiazepine‐related drugs pass readily through the placenta, and are associated with adverse birth outcomes (spontaneous abortion, preterm birth, and when used in the third semester loppy infant syndrome or respiratory problems) 25 …”

Section: Introductionmentioning

confidence: 99%

Trajectories of antidepressant drugs during pregnancy: A cohort study from a community‐based sample

Cabaillot

Bourset

Mulliez

et al. 2020

Brit J Clinical Pharma

View full text Add to dashboard Cite

The aim of this study was to monitor the trajectories of antidepressant use during pregnancy and the postpartum period among women chronically treated with antidepressants before their pregnancy, and to assess characteristics associated with each trajectory. Methods: This cohort study included all pregnant women whose data were included in the General Sample of Beneficiaries (EGB) database affiliated with the French Health Insurance System, from 2009 to 2014. Women were followed up until 6 months after childbirth. Chronic treatment was defined as exposure over the 6-month period preceding pregnancy. A group-based trajectory model (GBMT) was estimated to identify distinctive longitudinal profiles of antidepressant use. Results: Among 760 women chronically treated with antidepressants before their pregnancy, 55.8% stopped their treatment permanently in the first trimester, 20.4% discontinued it for a minimum of 3 months and resumed it postpartum, and 23.8% maintained it throughout pregnancy and postpartum. No sociodemographic or medical characteristics were associated with any trajectory group. Women who maintained treatment presented more frequent obstetric complications and postpartum psychiatric disorders. Among women who interrupted treatment, prescription of benzodiazepines and anxiolytics decreased initially but rose postpartum to a higher level than before pregnancy. Conclusions: Pregnant women treated with antidepressant require a re-evaluation of psychiatric treatment. It is necessary to pay attention to obstetric complications for severely depressed women. Additionally, as relapse was associated with increased benzodiazepine use, it is important to carefully monitor all women who stop antidepressant treatment during pregnancy.

show abstract

Prevalence of benzodiazepines and benzodiazepine-related drugs exposure before, during and after pregnancy: A systematic review and meta-analysis

Cited by 58 publications

References 63 publications

Treatment of Peripartum Depression with Antidepressants and Other Psychotropic Medications: A Synthesis of Clinical Practice Guidelines in Europe

Treatment of Peripartum Depression with Antidepressants and Other Psychotropic Medications: A Synthesis of Clinical Practice Guidelines in Europe

Pregnancy and Neonatal Outcomes After Exposure to Alprazolam in Pregnancy

Trajectories of antidepressant drugs during pregnancy: A cohort study from a community‐based sample

Contact Info

Product

Resources

About