Safety Profile of Benzodiazepines During Pregnancy

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Objective: Benzodiazepines are commonly and frequently prescribed during pregnancy for various psychiatric disorders. Their use has continued to be debated due to possible congenital effects though evidence about possible teratogenicity is equivocal. We aim to evaluate the association between the benzodiazepine use during pregnancy and their risk of causing major congenital malformations. Methods: In order to understand the effects of benzodiazepine use during pregnancy, A MEDLINE search of the literature between 1966 and 2023 was conducted with the terms “pregnancy,” “benzodiazepines,” “diazepam,” “clonazepam, alprazolam,” “chlordiazepoxide,”,” “lorazepam,” “fetus,” and “neonates.” Results: The most commonly prescribed benzodiazepines during pregnancy are alprazolam, lorazepam and diazepam. Although benzodiazepine use during pregnancy was associated with a small increased risk of overall congenital malformations and heart defects in some studies, it was at doses higher than the usual daily dose. Our findings suggest that therapeutic benefits of benzodiazepines must be considered despite the potential risks. The recent studies suggest safety of using Diazepam, chlordiazepoxide with similar data for Lorazepam at low doses. It is still prudent for physicians to carefully monitor response on lowest possible dosages of benzodiazepines while dividing its daily use with longest safety data for pregnancy females. Consideration should also be given for monotherapy for the shortest possible duration while continuously recommending alternative modalities. Conclusions: In spite of benzodiazepine use during pregnancy being shown to have congenital malformation in a few studies, this data is still insufficient to be conclusive. Therefore, it is necessary to consider safety profile, low dosages, shortest possible benzodiazepine usage as a monotherapy while alternative therapies besides medications should also be actively recommended.