Use of benzodiazepines and benzodiazepine receptor agonists during pregnancy: neonatal outcome and congenital malformations

Wikner, Birgitta Norstedt; Stiller, Carl‐Olav; Bergman, Ulf; Asker, Charlotte; Källén, Bëngt

doi:10.1002/pds.1457

Cited by 203 publications

(124 citation statements)

References 23 publications

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“…80,81 In pregnant women, with regard to teratogenicity, earlier studies of benzodiazepines tend to report an association with oral clefts; 82 however, later research generally failed to find this association. 83 Their use in pregnancy can elevate the risk of neonatal withdrawal symptoms such as hypertonia, hyperreflexia, tremors, bradycardia, and sleep disturbance. 84,85 Third trimester exposure has also been associated with the ''floppy infant syndrome,'' characterized by low APGAR scores, hypothermia, muscular hypotonia, and sluggish response to cold temperatures.…”

Section: Benzodiazepinesmentioning

confidence: 99%

Perinatal Generalized Anxiety Disorder: Assessment and Treatment

Misri

Abizadeh

Sanders

et al. 2015

Journal of Women's Health

102

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Perinatal generalized anxiety disorder (GAD) has a high prevalence of 8.5%-10.5% during pregnancy and 4.4%-10.8% postpartum. Despite its attendant dysfunction in the patient, this potentially debilitating mental health condition is often underdiagnosed. This overview will provide guidance for clinicians in making timely diagnosis and managing symptoms appropriately. A significant barrier to the diagnosis of GAD in the perinatal population is difficulty in distinguishing normal versus pathological worry. Because a perinatal-specific screening tool for GAD is nonexistent, early identification, diagnosis and treatment is often compromised. The resultant maternal dysfunction can potentially impact mother-infant bonding and influence neurodevelopmental outcomes in the children. Comorbid occurrence of GAD and major depressive disorder changes the illness course and its treatment outcome. Psychoeducation is a key component in overcoming denial/stigma and facilitating successful intervention. Treatment strategies are contingent upon illness severity. Cognitive behavior therapy (CBT), relaxation, and mindfulness therapy are indicated for mild GAD. Moderate/severe illness requires pharmacotherapy and CBT, individually or in combination. No psychotropic medications are approved by the FDA or Health Canada in pregnancy or the postpartum; off-label pharmacological treatment is instituted only if the benefit of therapy outweighs its risk. SSRIs/SNRIs are the first-line treatment for anxiety disorders due to data supporting their efficacy and overall favorable side effect profile. Benzodiazepines are an option for short-term treatment. While research on atypical antipsychotics is evolving, some can be considered for severe manifestations where the response to antidepressants or benzodiazepines has been insufficient. A case example will illustrate the onset, clinical course, and treatment strategies of GAD through pregnancy and the postpartum.

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Section: Benzodiazepinesmentioning

confidence: 99%

Perinatal Generalized Anxiety Disorder: Assessment and Treatment

Misri

Abizadeh

Sanders

et al. 2015

Journal of Women's Health

102

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“…При их применении наблю-дается такое осложнение, как, например, абстинентный синдром, однако данные о тератогенности бензодиазе-пинов немногочисленны и противоречивы. В ряде эпи-демиологических исследований использование бензо-диазепинов в первом триместре было ассоциировано с орофациальными расщелинами [91], ВПС [92] и атре-зией желудочно-кишечного тракта [93]. Однако, в других исследованиях не было получено данных о развитии врожденных аномалий при использовании бензодиазе-пинов [94].…”

Section: обзор литературыunclassified

Pharmacological safety during pregnancy: the principles of teratogenesis and teratogenicity of drugs

Reshetko¹,

Луцевич²,

Клименченко³

2016

Pediatr. farmakol.

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ВВЕДЕНИЕ В настоящее время в мировой медицинской лите-ратуре крайне мало данных о воздействии лекарствен-ных средств (ЛС) в период беременности -как на организм матери, так и ее будущего ребенка [1,2]. Многие ЛС способствуют развитию таких осложнений беременности, как самопроизвольный выкидыш, пре-ждевременные роды, мертворождение, а также могут вызывать формирование врожденных аномалий разви-тия, церебрального паралича, рождение с низкой мас-сой, задержку умственного развития и поведенческие нарушения в последующем и пр. При этом риск развития врожденных аномалий у ребенка может быть обуслов-лен как прямым воздействием препарата на систему «мать-будущий ребенок», так и через влияние ЛС на отдельные процессы в организме матери или самого

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“…The results of these studies are somewhat conflicting, but the largest studies with a minimum of bias indicate no marked teratogenicity [Eros et al 2002;Wikner et al 2007]. The main exceptions are the studies by Laegreid and colleagues which concern women who have used high amounts of such drugs.…”

Section: Benzodiazepinesmentioning

confidence: 99%

Antiepileptic drugs in women with epilepsy during pregnancy

Gedzelman¹,

Meador²

2012

Therapeutic Advances in Drug Safety

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Prescribing antiepileptic drugs (AEDs) in pregnancy is a challenge to the clinician. A multitude of questions arise that must be addressed even prior to conception. In women with proven epilepsy, it may be dangerous to stop or even change the AED regimen during pregnancy. Changes could lead to injury or death in both the mother and the fetus. In the rare cases when discontinuing an AED is plausible, it should be done methodically in consultation with the physician prior to conception. Most women with epilepsy are consigned to continue their AEDs before, during and after pregnancy. The metabolism of AEDs may change drastically during pregnancy. These changes must be addressed by the clinician. Drug levels should be monitored consistently during pregnancy. The risks to the fetus must be delineated in terms of side effects from specific drugs as well as risks from the seizure disorder itself. Many AEDs have well known teratogenic effects, and these must be elucidated to the mother. There are risks (theoretical and evidence based) for obstetrical complications, poor neonatal outcomes, congenital malformations and even cognitive effects on the child later in life. These risks are addressed in this article with respect to individual AEDs. Recommendations include but are not limited to preconception counseling, taking folate pre and post conception, prescribing the most effective AED while minimizing risks, and avoiding polytherapy and valproate if possible.

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Use of benzodiazepines and benzodiazepine receptor agonists during pregnancy: neonatal outcome and congenital malformations

Abstract: Maternal use of BZD and/or HBRA may increase the risk for preterm birth and low birth weight and cause neonatal symptoms, but does not appear to have a strong teratogenic potential. The tentative association with pylorostenosis and alimentary tract atresia needs confirmation.

Cited by 203 publications

References 23 publications

Perinatal Generalized Anxiety Disorder: Assessment and Treatment

Perinatal Generalized Anxiety Disorder: Assessment and Treatment

Pharmacological safety during pregnancy: the principles of teratogenesis and teratogenicity of drugs

Antiepileptic drugs in women with epilepsy during pregnancy

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