Diazepam Pregnancy and Breastfeeding Warnings
Diazepam Pregnancy Warnings
Physicians are encouraged to register patients before fetal outcome is known (e.g., ultrasound, results of amniocentesis, etc) into the Antiepileptic Drug (AED) Pregnancy Registry at 1-888-233-2334 or 1-888-AED-AED4. This is an ongoing study at the Massachusetts General Hospital/Harvard Medical School. This study is designed to monitor the outcomes of pregnant women exposed to antiepileptic drugs in order to determine which therapies are associated with increased risk.
Diazepam has been assigned to pregnancy category D by the FDA. It has been suggested that there is an increased risk of congenital malformations and other developmental abnormalities associated with the use of benzodiazepine drugs. There may be nonteratogenic risks associated with the use of benzodiazepines during pregnancy. There have been reports of neonatal flaccidity, respiratory and feeding difficulties, and hypothermia in children born to mothers who have been receiving benzodiazepines late in pregnancy. Children born to mothers receiving benzodiazepines on a regular basis late in pregnancy may be at risk of experiencing withdrawal symptoms during the postnatal period. Diazepam has been shown to be teratogenic in animal studies at approximately eight times the maximum recommended human dose. The manufacturer recommends that the use of diazepam in women of childbearing potential, and specifically during known pregnancy, should only be considered when the clinical situation warrants the risk to the fetus. If diazepam is used during pregnancy, or if the patient becomes pregnant while taking this drug, the patient should be apprised of the potential hazard to the fetus. Patients should also be advised that if they become pregnant during therapy or intend to become pregnant they should communicate with their physician about the desirability of discontinuing the drug. Special care should be taken when diazepam is used during labor and delivery, because high single doses may produce irregularities in the fetal heart rate and hypotonia, poor sucking, hypothermia, and moderate respiratory depression in the neonate. With newborn infants, the enzyme system involved in the breakdown of the drug is not yet fully developed (especially in premature infants).
Diazepam Breastfeeding Warnings
One report on concentrations in breast milk of medications used during general anesthesia has stated that diazepam and nordiazepam were not detectable in any sample of milk or blood. This report stated that the maximum possible infant exposure index for diazepam would be 3%. Therefore, the authors concluded that the amount of diazepam excreted into breast milk when used for general anesthesia does not warrant interruption in breast-feeding. Some clinicians feel that in cases where a benzodiazepine is required on a continuing basis and the mother feels strongly about continuing to breast-feed, a short acting benzodiazepine like oxazepam may be a safer alternative.
Diazepam is excreted into human milk. Sedation, lethargy and weight loss have been reported in nursing infants. The American Academy of Pediatrics describes diazepam as a drug whose effect on nursing infants is unknown but may be of concern. The manufacturer states that breast-feeding is not recommended in patients receiving diazepam.
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