From the Guidelines
Lorazepam should be avoided during pregnancy unless absolutely necessary due to significant risks to the developing baby. This benzodiazepine medication crosses the placenta and may cause harm, particularly when used in the first trimester when it's associated with an increased risk of certain birth defects including cleft lip and palate 1. Use during the third trimester or near delivery can lead to "floppy infant syndrome," where the newborn experiences sedation, breathing difficulties, hypothermia, and feeding problems. Long-term use during pregnancy may cause the baby to develop physical dependence, resulting in withdrawal symptoms after birth including irritability, high-pitched crying, tremors, and feeding difficulties.
Some key points to consider when evaluating the risks of lorazepam during pregnancy include:
- The potential for birth defects, particularly cleft lip and palate, when used in the first trimester
- The risk of "floppy infant syndrome" when used near delivery
- The potential for physical dependence and withdrawal symptoms in the newborn
- The importance of gradual tapering off the medication or switching to safer alternatives if necessary
If you're pregnant and currently taking lorazepam, don't stop suddenly as this could cause withdrawal symptoms; instead, consult your healthcare provider about gradually tapering off the medication or switching to safer alternatives 1. For women with anxiety or insomnia during pregnancy, non-medication approaches like cognitive behavioral therapy should be considered first whenever possible. It's essential to weigh the benefits and risks of lorazepam use during pregnancy and to prioritize the health and well-being of both the mother and the developing baby.
From the FDA Drug Label
The clinical significance of the above findings is not known However, an increased risk of congenital malformations associated with the use of minor tranquilizers (chlordiazepoxide, diazepam, and meprobamate) during the first trimester of pregnancy has been suggested in several studies. Because the use of these drugs is rarely a matter of urgency, the use of lorazepam during this period should be avoided The possibility that a woman of childbearing potential may be pregnant at the time of institution of therapy should be considered. Patients should be advised that if they become pregnant, they should communicate with their physician about the desirability of discontinuing the drug Infants of mothers who ingested benzodiazepines for several weeks or more preceding delivery have been reported to have withdrawal symptoms during the postnatal period Lorazepam oral concentrate may harm your unborn baby. You and your healthcare provider should decide if you should take lorazepam oral concentrate while you are pregnant.
The risks of taking lorazepam (Ativan) during pregnancy include:
- Increased risk of congenital malformations associated with the use of minor tranquilizers during the first trimester of pregnancy
- Withdrawal symptoms in infants born to mothers who ingested benzodiazepines for several weeks or more preceding delivery
- Potential harm to the unborn baby, and the decision to take lorazepam during pregnancy should be made with a healthcare provider It is recommended to avoid the use of lorazepam during pregnancy, especially during the first trimester, unless the use of the drug is a matter of urgency 2.
From the Research
Risks of Taking Lorazepam During Pregnancy
- The use of lorazepam during pregnancy may pose risks to the fetus, including the potential for congenital defects and neurobehavioural problems 3, 4.
- Studies have shown that benzodiazepines, including lorazepam, can cross the placenta and affect the fetus, with potential symptoms including sedation, hypotonia, and reluctance to suck 5, 4.
- The risk of "floppy infant syndrome" is also associated with the use of benzodiazepines, including lorazepam, during late pregnancy and labor 5, 4.
- Additionally, the use of lorazepam during pregnancy may increase the risk of neonatal withdrawal symptoms, including apnoeic spells, cyanosis, and impaired metabolic responses to cold stress 4.
- It is recommended that the therapeutic value of lorazepam be weighed against the potential risks to the fetus, and that the lowest effective dose be used for the shortest possible duration 3.
Considerations for Use During Pregnancy
- The available literature suggests that it is uncertain whether the potential benefits of lorazepam to the mother outweigh the risks to the fetus 3.
- Physicians should consider using benzodiazepines with established safety records, such as diazepam and chlordiazepoxide, instead of lorazepam 3.
- High peak concentrations of lorazepam should be avoided, and the daily dosage should be divided into two or three doses to minimize the risk of adverse effects on the fetus 3.
- The use of lorazepam during the first trimester should be avoided, and multidrug regimens should be avoided to minimize the risk of adverse effects on the fetus 3.