From the Guidelines
No benzodiazepines are considered completely safe during pregnancy, and they should generally be avoided when possible. The study from 1 provides guidance on the use of sedatives and hypnotics, including benzodiazepines, but does not specifically address their safety during pregnancy. However, it does mention that these medications are "Not recommended during pregnancy or nursing", highlighting the potential risks associated with their use in pregnant women. Some key points to consider when evaluating the safety of benzodiazepines during pregnancy include:
- The potential risks of benzodiazepine use during pregnancy, such as preterm birth, low birth weight, neonatal withdrawal syndrome, and potential neurodevelopmental effects
- The importance of evaluating the risk-benefit ratio for each patient, considering both the mother's mental health needs and potential fetal risks
- The recommendation to use non-pharmacological approaches, such as cognitive behavioral therapy, as a first-line treatment whenever possible
- The need for careful management and monitoring of women who become pregnant while taking benzodiazepines, including avoiding abrupt discontinuation and consulting with a healthcare provider to develop an appropriate management plan. It's also worth noting that some benzodiazepines, such as lorazepam and clonazepam, may be considered relatively safer options due to their shorter half-lives and less active metabolites, but they should still be used with caution and only when absolutely necessary 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Benzodiazepines and Pregnancy
Benzodiazepines are a class of drugs that are commonly used to treat anxiety, insomnia, and other conditions. However, their use during pregnancy is a concern due to the potential risks to the fetus.
Safe Benzodiazepines During Pregnancy
- Chlordiazepoxide is considered to be safe during pregnancy, as stated in the study 2.
- Diazepam may be safe during pregnancy, but its use during lactation is not recommended due to the risk of lethargy, sedation, and weight loss in infants, as reported in 2 and 3.
- Oxazepam, lorazepam, and nitrazepam may penetrate the placenta more slowly than diazepam, but the clinical significance of this is uncertain, as noted in 4.
- Alprazolam should be avoided during pregnancy due to the increased risk of spontaneous abortion, low birth weight, and low Apgar score, as found in 5.
Precautions and Considerations
- The use of benzodiazepines during the first trimester of pregnancy should be avoided whenever possible, as stated in 4, 2, and 3.
- The lowest effective dose of benzodiazepines should be used during pregnancy, and the duration of treatment should be as short as possible, as recommended in 2 and 6.
- Benzodiazepines should be used with caution during lactation, as they can be excreted into breast milk and may cause sedation and other adverse effects in nursing infants, as reported in 4 and 6.