Is Lorazepam (Ativan) safe to administer during pregnancy?

From the Guidelines

Ativan (lorazepam) should be used with caution during pregnancy, and its use is not recommended unless the benefits outweigh the risks, due to potential risks to the developing fetus, such as increased risk of cleft lip/palate and neonatal withdrawal symptoms 1. When considering the use of Ativan during pregnancy, it is essential to weigh the potential benefits against the risks. The provided evidence does not specifically address the safety of Ativan during pregnancy, but it does discuss the use of other medications during pregnancy, highlighting the importance of careful consideration and monitoring. Some key points to consider when evaluating the use of Ativan during pregnancy include:

• Potential risks to the developing fetus, such as increased risk of cleft lip/palate if used in the first trimester
• Neonatal withdrawal symptoms if used near delivery
• Possible associations with neurodevelopmental effects
• Alternative treatments, such as certain SSRIs (like sertraline) or cognitive behavioral therapy, may be preferred for anxiety during pregnancy
• Untreated severe anxiety or seizures may also pose risks to both mother and baby It is crucial for healthcare providers to carefully evaluate the need for Ativan during pregnancy and to monitor patients closely if the medication is prescribed. Any woman who is pregnant or planning pregnancy should discuss medication options with her healthcare provider to determine the best course of treatment. If currently taking Ativan and pregnant, it is essential not to stop the medication abruptly without medical supervision 1.

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 In humans, blood levels obtained from umbilical cord blood indicate placental transfer of lorazepam and lorazepam glucuronide. 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 use during pregnancy is not recommended, especially during the first trimester, due to the potential risk of congenital malformations.

• Key points: + Increased risk of congenital malformations associated with minor tranquilizers during the first trimester + Use of lorazepam during this period should be avoided + Patients should be advised to communicate with their physician if they become pregnant + Placental transfer of lorazepam and lorazepam glucuronide has been reported + Infants of mothers who ingested benzodiazepines may experience withdrawal symptoms during the postnatal period 2

From the Research

Safety of Ativan During Pregnancy

• There are no direct studies on the safety of Ativan (lorazepam) during pregnancy in the provided evidence.
• However, a study on benzodiazepines in general, which includes Ativan, found that their use during pregnancy is associated with preterm delivery and low birth weight 3.
• The same study also mentions that benzodiazepines can cause short-term neonatal effects such as hypotonia, depression, and withdrawal, but long-term sequelae are poorly understood 3.
• It is recommended to taper off benzodiazepines to avoid withdrawal symptoms, but the safety of using them during pregnancy is still a concern 3.

Comparison to Other Medications

• Studies on selective serotonin reuptake inhibitors (SSRIs) have shown that they can cause neonatal withdrawal syndrome in infants exposed to them during the third trimester of pregnancy 4, 5.
• SSRIs have also been linked to an increased risk of persistent pulmonary hypertension of the newborn, with some medications having a higher risk than others 6.
• While Ativan is not an SSRI, its use during pregnancy may still pose risks to the fetus, and alternative treatments or careful monitoring may be necessary.

Key Findings

• Benzodiazepines, including Ativan, should be used with caution during pregnancy due to potential risks to the fetus 3.
• More research is needed to fully understand the effects of Ativan and other benzodiazepines on fetal development and neonatal health.
• Healthcare providers should carefully weigh the benefits and risks of using Ativan during pregnancy and consider alternative treatments or monitoring strategies to minimize potential harm.