Posted by Claudia Grazioso on May 26, 2011
If you’re a parent, chances are you’ve experienced driving anxiety, panic attacks and jolts of fear. But then usually something kicks in — an inner voice that talks you down… an innate neurological ability to calm yourself. Imagine living without that ability, without that voice. Imagine the panic just running wild, non-stop. Anxiety disorders can be crippling, and the medicines used to treat them can seem like a Godsend. But are they safe for use during pregnancy? As always, that seems to be up for serious debate.
Ativan (lorazepam) is frequently prescribed to treat anxiety disorders. It belongs to a group of drugs called benzodiazepines. BZDs treat clinical anxiety by helping to depress the central nervous system, and rebalance the brain chemicals that, when unbalanced, can make life really, really miserable.
Antidepressants like SSRIs and SNRIs (Selective Serotonin Reuptake Inhibitors and Serotonin Norepinephrine Reuptake Inhibitors) are classified as Category C drugs, meaning that in lab tests on animal fetuses, there seemed to be a risk of birth defects to the fetuses exposed to them. However, because no clinical studies have been conducted on pregnant humans, no one is really willing to say for sure what pregnant moms should do, even though it is believed that there is an increased risk to the developing fetus. Because of this, lorazepam is contraindicated during pregnancy.
You would think that a drug being contraindicated during pregnancy would kind of close the discussion on whether pregnant women should take it, but you would be wrong. You would also think that a clear-evidence-of-risk-to-the fetus Category D classification would translate easily into “D as in DON’T take this drug if you’re pregnant.” But again, you would be wrong. Experts are hesitant to take a definitive stand, so the call is left to the woman and her doctor. The official stance is that if the benefits to the mother outweigh the risks to the child, then it’s okay to take lorazepam.
If you are faced with that decision, one of the best things you can do is learn what the actual risks are to your baby.
Some infants whose mothers have taken lorazepam during pregnancy showed signs of withdrawal from the drug. These signs included hypoactivity, hypotonia, hypothermia, respiratory depression and an impaired metabolic response to cold. The risk of withdrawal symptoms seems connected to lorazepam taken in the later part of pregnancy. Additionally, lorazepam does enter breast milk, and can have a sedative effect on a baby. The American Pediatric Association has expressed concern about the effects of this drug on nursing infants, especially since an infant who is sedated might have a hard time suckling.
The other birth defects possibly connected to lorazepam are physical malformations, primarily cardiac or facial deformities (an increase in the risk of Cleft Palate was observed in laboratory mice) and inguinal hernias. There is also believed to be a possibility that pre-natal exposure to lorazepam can result in neurodevelopmental problems and/or a reduced IQ. And finally, a few studies have found a slightly increased risk of miscarriage for women who take lorazepam, while some have found a “notable” increase.
Clearly, when it comes to medications like Ativan, much more information is needed. In the interim, if you are pregnant and taking this medication, consider having a discussion with your doctor.