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Combination benzodiazepine, antidepressant use during pregnancy warrants caution

Although benzodiazepine use during pregnancy did not seem to be linked to congenital or cardiac malformations, its use in combination with antidepressants may increase the risk for congenital malformations, study data published in Journal of Clinical Psychiatry showed.

“Due to conflicting results across studies, it is unknown if benzodiazepine exposure during pregnancy is associated with an increased risk of congenital malformations,” Sophie Grigoriadis, MD, PhD, from the department of psychiatry, Sunnybrook Health Sciences Centre and University of Toronto, Canada, and colleagues wrote. “Up-to-date information about risks constitutes a critical component of the risk-benefit profile that clinicians and patients require to inform their treatment decisions.”

In a systematic review and meta-analysis, researchers examined whether antenatal benzodiazepine exposure as monotherapy and in combination with antidepressants affected the risk for congenital malformations among pregnant women. Grigoriadis and colleagues searched online clinical databases for cohort studies with prospectively collected data on the risk for malformations in offspring exposed and unexposed to benzodiazepines.

Eight studies were included in analysis. The pooled results showed that benzodiazepine exposure in utero was not linked to increased risk for congenital malformations (OR = 1.13; 95% CI, 0.99-1.3).

When the investigators examined five studies that specifically assessed exposure to benzodiazepines in the first trimester, the investigators found no significant risk for congenital malformation, nor did they find a significant effect when they examined four studies exploring prenatal benzodiazepine use and cardiac malformations. However, combined use of benzodiazepines and antidepressants in the first trimester was linked to an increased risk for major congenital malformations (OR = 1.4; 95% CI, 1.09-1.8) in three studies, according to the results.

“This study provides more evidence that the risk-benefit ratio must be carefully considered and that it must be individual for every woman and her family,” Grigoriadis and colleagues wrote. “Mothers are motivated to do what is best for their baby, and treatment of their illness must certainly be given heavy consideration. It is important not to lose sight of our role as health care providers, which is to work collaboratively with those we care for and do what is in their best interest within the context of their family.” – by Savannah Demko

Disclosures: Grigoriadis reports personal fees from Compendium of Pharmaceuticals and Specialties, Eli Lilly, Psychotherapy Essentials to Go and UpToDate. Please see the study for all other authors’ relevant financial disclosures.