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 Infants of mothers who ingested benzodiazepines for several weeks or more preceding delivery have been reported to have withdrawal symptoms during the postnatal period Symptoms such as hypoactivity, hypotonia, hypothermia, respiratory depression, apnea, feeding problems, and impaired metabolic response to cold stress have been reported in neonates born of mothers who have received benzodiazepines during the late phase of pregnancy or at delivery
The benefits of taking lorazepam (Ativan) during pregnancy are not established. In fact, the use of lorazepam during pregnancy should be avoided, especially during the first trimester, due to the potential risk of congenital malformations and withdrawal symptoms in newborns 1.
From the Research
Lorazepam is generally not recommended during pregnancy unless the potential benefits clearly outweigh the risks. There are no established benefits specific to pregnancy for taking lorazepam. This medication belongs to the benzodiazepine class and is primarily used to treat anxiety, insomnia, and seizures in the general population. During pregnancy, lorazepam use has been associated with potential risks including neonatal withdrawal symptoms, respiratory problems in newborns, and possible birth defects, particularly when used in the first trimester 2.
Key Considerations
- The use of benzodiazepines during pregnancy is associated with preterm delivery and low birth weight 2.
- Short-term neonatal effects of hypotonia, depression, and withdrawal are described but long-term sequelae, if any, are poorly understood 2.
- Benzodiazepines are associated with physical dependence and withdrawal symptoms which can be serious 2.
- To avoid withdrawal, tapering off these medications is recommended 2.
Alternative Treatments
- Alternative treatments with better safety profiles during pregnancy are usually preferred, such as antidepressant drugs which could be used as an alternative for treating anxiety and insomnia 3.
- Psychotherapy is a potential alternative to medication for the treatment of depression, anxiety disorders, and insomnia 3.
Recommendations
- If a pregnant woman has severe anxiety or seizure disorders that require treatment, healthcare providers may sometimes prescribe lorazepam after careful consideration, but typically at the lowest effective dose for the shortest duration possible.
- Any pregnant woman currently taking lorazepam or considering its use should consult with her healthcare provider to discuss individual circumstances, risks, benefits, and potential alternatives.
- Coordination of care with the patient, her husband or partner, and the obstetrician is essential, as is careful medical record documentation when treating pregnant patients with psychiatric disorders 4.