Effects of Benzodiazepines, SRIs During Pregnancy on Mothers and Newborns

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Most medication use occurred early in the pregnancies.
Most medication use occurred early in the pregnancies.

While neither panic disorder nor generalized anxiety disorder (GAD) appeared to cause pregnancy complications, treatment with a serotonin reuptake inhibitor (SRI) or a benzodiazepine was found to shorten the duration of gestation slightly, and treatment with SRIs were also associated with hypertensive disease in the mother during pregnancy and with cesarean delivery, according to a study in JAMA Psychiatry.

This cohort study conducted between July 1, 2005 and July 14, 2009 included 2654 women age ≥18 who had not yet reached 17 weeks of pregnancy. Only women with single births who were not treated with insulin for diabetes were included in the study. All were questioned at home using the World Mental Health Composite International Diagnostic Interview prior to 17 weeks of pregnancy, and then again by telephone at 28±2 weeks gestation, and finally at 8±4 weeks after delivery. Interviewers were trained and some interview tapes were reviewed for quality control.

Most medication use occurred early in the pregnancies. Benzodiazepine use was associated with cesarean delivery (odds ratio [OR], 2.45; 95% CI, 1.36-4.40), low birth weight (OR, 3.41; 95% CI, 1.61-7.26), and use of ventilator support for the newborn (OR, 2.85; 95% CI, 1.2-6.9). Maternal serotonin reuptake inhibitor use correlated with hypertensive diseases of pregnancy (OR, 2.82; 95% CI, 1.58-5.04), preterm birth (OR, 1.56; 95% CI, 1.02-2.38), the use of minor respiratory interventions (OR, 1.81; 95% CI, 1.39-2.37), and cesarean birth (OR, 0.91; 95% CI, 0.66-1.26).

Put another way, for benzodiazepine treatment, rates of ventilator support increased by 61 of 1000 neonates, and gestation was shortened by 3.6 days. With maternal SRI use, 152 of 1000 additional newborns required minor respiratory interventions. and gestation was shortened by 1.8 days; and 53 of 1000 additional women experienced hypertensive diseases of pregnancy. SRI use was also associated with cesarean delivery.

Disclosure: Dr Yonkers reported receiving consulting fees from Juniper and Marinus Pharmaceuticals and receiving royalties for a chapter written for Up To Date.

Reference

Yonkers KA, Gilstad-Hayden K, Forray A, Lipkind HS. Association of panic disorder, generalized anxiety disorder, and benzodiazepine treatment during pregnancy with risk of adverse birth outcomes [published online September 13, 2017]. JAMA Psychiatry. doi:10.1001/jamapsychiatry.2017.2733

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