Ativan & Pregnancy | Is It Safe?

Pregnancy can bring about or worsen psychiatric disorders, especially anxiety and depression. Ativan, the brand name for lorazepam, is one of the most commonly prescribed benzodiazepines for the treatment of panic and anxiety disorders. 

However, the use of benzodiazepines like Ativan during pregnancy is dangerous because of the risk of birth defects and neonatal withdrawal. The best way for pregnant women who take lorazepam to avoid unwanted complications is by discussing a taper with their prescribing doctor.

What Is Ativan?

Lorazepam is a benzodiazepine that intensifies the neurotransmitter gamma-aminobutyric acid (GABA) in the central nervous system (CNS). Increasing GABA results in relaxation, drowsiness, and sometimes euphoria. 

Other benzodiazepines include:

• Valium (diazepam)
• Klonopin (clonazepam)
• Xanax (alprazolam)

Even if you take low doses of lorazepam, you may experience some side effects. 

Common side effects of Ativan include:

• dizziness
• sedation 
• coordination problems
• weakness 

Lorazepam may be safer than other benzodiazepines because a lower percentage of the drug is able to cross into the placenta. It’s also eliminated from your body at a slower rate and you would need less frequent doses.

Risks Of Taking Ativan While Pregnant

Ativan is a controlled substance with potential risks for dependence and withdrawal, which can be potentially harmful to a growing fetus. SSRI (selective-serotonin reuptake inhibitors) antidepressants are considered a safe alternative to benzodiazepines during pregnancy. 

However, your doctor may choose to keep you on lorazepam if the risks outweigh the benefits for you and your baby. 

Congenital Malformations

The first trimester, which is roughly the first three months of pregnancy, is when a baby’s bones, heart, organs, and brain are developing. During this trimester, there is an increased risk of malformation while taking benzodiazepines. 

Malformations may include:

• cleft lip
• cleft palate
• anal atresia

Floppy-Infant Syndrome

Even in low doses, babies can develop floppy-infant syndrome, which is characterized by hypotonia (muscle weakness), hypothermia, and neurological depression. This condition can be diagnosed within the first five minutes after birth during the baby’s Apgar test.

Neonatal Withdrawal Syndrome

If you take lorazepam regularly, especially during the third trimester, your baby could become physically dependent on it. Benzodiazepine-dependent neonates (newborns) could develop withdrawal symptoms. These symptoms may appear within the first few days or up to 3 weeks after they are born. 

Neonatal withdrawal symptoms include:

• overactive muscles
• hyperactive reflexes
• restlessness
• irritability
• seizures
• excessive crying
• tremors
• slow heart rate
• bluish skin
• abdominal distention
• respiratory depression

Intravenous (IV) lorazepam should be avoided because it increases the risk for severe withdrawal symptoms in neonates. 

Treatment For Neonatal Withdrawal

Medical professionals will monitor the baby for at least a week or until the baby’s condition stabilizes. Lorazepam withdrawal can last several months, and if symptoms are severe the baby may require medicated treatment. 

The best way to prevent neonatal withdrawal is by tapering lorazepam with the help of a healthcare professional before the baby is born. Tapering is a slow process that may take several weeks to ensure your body and baby can safely adapt to each new dose. 

Is Lorazepam Safe While Breastfeeding?

Small amounts of lorazepam are excreted in breast milk and passed onto the baby when they breastfeed. Despite this fact, studies show no abnormal reactions occurred from breastfeeding while using lorazepam. 

However, the Food and Drug Administration (FDA) strongly advises against breastfeeding while taking benzodiazepines. Adverse effects including sedation and difficulty suckling may occur depending on the dose and frequency.

Lorazepam Addiction Treatment

Substance use disorder (SUD), also known as addiction, is a chronic disease that affects the mind and body. Addiction is characterized by compulsive drug use despite consequences and the inability to stop on your own. 

Comprehensive treatment for addiction should include behavioral therapy and inpatient rehab to address cravings and negative behavior patterns.
If you or a loved one is seeking addiction treatment, please contact Ark Behavioral Health today.