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Benzodiazepines during pregnancy

From: Eduardo Dunayevich <dunayev@penn.com>
Date: Fri, 12 Jan 1996 23:35:37 -0500
Subject: Benzodiazepines during pregnancy

It is believed that most infants born to mothers who have taken high doses of benzos throughout their pregnancies are born without overt consequences and that the main concerns are sedation and withdrawal in the newborn (Laegreid L, Hagberg G, Lundberg A: The effect of benzodiazepines on the fetus and the newborn. Neuropediatrics 1992; 23: 18-23 and Bergman U, Rosa FW, Baum C, Wiholm BE, Faich GA: Effects of exposure to benzodiazepine during fetal life. Lancet 1992; 340: 694-696).

From: Eduardo Dunayevich <dunayev@penn.com>
Date: Fri, 23 Feb 1996 19:54:31 -0500
Subject: Clonazepam during pregnancy

Clonazepam also appears fairly safe according to the American Psychiatric Press, Inc., Textbook of Psychopharmacology.

Date: Tue, 19 Mar 1996 09:28:21 -0600
From: dr-bob@uchicago.edu (Robert Hsiung)
Subject: Alprazolam during pregnancy

My understanding is that there have been concerns that exposure to alprazolam during the 1st trimester increased the risk of cleft lip and palate, but that that has not been substantiated in controlled studies.

From: rbrand@MEM.po.com (Richard Brand, MD)
Date: Sat, 23 Mar 1996 10:32:33 -0500
Subject: Alprazolam during pregnancy

There have been several recent postings regarding the occasional use of alprazolam in the first trimester. There are conflicting data regarding possible oral clefts.

One consideration here is that in unmedicated pregnancies, there is a 2-4% incidence of spontaneous malformations, most of which are thankfully minor. However, given this background, the dr. and pt. need to consider whether the patient will blame herself forever if the baby has something wrong with him or her, a special concern in my practice with anxious women. Alternatively, such patients may do worse if told they can't take anything, and may paradoxically take none or less, as long as they know they won't go off a catastrophic cliff.

I prefer TCAs in low doses for regular use in the first trimester. Two alternatives for prns for sedation are chlorpheniramine (believed safe and probably preferable to diphenhydramine early on) and 10-25 mg CPZ (widely used in the past for morning sickness).

--Valerie Raskin, M.D.

As you mention, factors of guilt are quite relevant in this population, and there is no medication, food additive or exercise regimen that will assuage such feelings in vulnerable pregnant women in the event of a malformation, even though malformations occur when no pharmacology has been applied. That having been said, occasional PRN use of alprazolam is sometimes essential, even in the 1st trimester, when the clinical picture warrants its use. For the latest poop on the teratogenicity of these meds try contacting Lee S. Cohen, MD, at the Mass. General. He researches these areas, and is quite helpful in difficult cases.

From: Cdbojrab@aol.com (Christopher D. Bojrab, M.D.)
Date: Tue, 4 Feb 1997 06:41:40 -0500 (EST)
Subject: Clonazepam during pregnancy

I recall having a bipolar patient about a year ago who was on Klonopin (clonazepam) and became pregnant. I reviewed some of the literature and remember that Klonopin seemed relatively safe in pregnancy.

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