Due to its deleterious effects on the child, one should renounce diazepam in pregnancy as much as possible. In this article you will find out where the risks lie and which alternatives exist.
Diazepam is a benzodiazepine . It calms, relaxes muscles and is useful for treating or preventing epileptic seizures. About the placenta it goes from the mother to the child. There it reaches a concentration up to three times as high as in the mother’s blood.
Depending on the stage of pregnancy, there are various effects on the development of the fetus. Older studies have reported an increased incidence of cleft lip or cleft palate or more complex malformations when diazepam is used in the first three months. Recent studies could not confirm that.
However, serious problems can be expected when diazepam is used between the fourth and ninth months. The transition from life in the mother’s abdomen to life without an umbilical cord can sometimes lead to complications that permanently disturb the baby’s development. Some babies are then apathetic, too quiet, hardly respond to external stimuli or drink very slowly. In some, the skin turns blue-red, because their blood absorbs too little oxygen. Breathing is often slowed down or it comes to the so-called “Floppy Infant Syndrome” (English floppy infant , flaccid child ‘), which can last several weeks. The baby does not cry, it seems powerless and limp.
As with the mother, the symptoms of withdrawal can also be very stressful for the child. These include, for example, convulsions. Since diazepam is broken down by a baby much slower than by an adult, it is likely that the symptoms improve only after a long time.
If the mother is dependent on diazepam, it will be a difficult start for the child. According to estimates, around two million people in Germany are dependent on benzodiazepines , more than half of whom are women. The risk of a baby having a dependent mother is around 1.5 percent.
Unfortunately, there are few experiences with pregnancy withdrawal. On an abrupt withdrawal should be waived in any case. The dose should be reduced step by step in order to minimize the burden. Since there are also drugs in low doses (see eg Diazepam 10 mg , Diezapam 5 mg ), the discontinuation with medical assistance and appropriate cooperation of the patient is quite feasible. If this succeeds in the first three months, chances are good that the child will develop normally. In addition, a close-meshed gynecological monitoring is recommended in order to be able to counteract any complications in good time.
For many – but not all – applications of Diazepam there are viable alternatives. In anticonvulsive treatment, such as epilepsy, and as a premedication before medical intervention benzodiazepines are currently without alternative.
If a sedative is needed, you can avoid promethazine in many cases . Although this substance overcomes the placenta, it has not shown any negative effects on the course of pregnancy in more than 3000 cases observed.
Quetiapine is often a viable option in psychotic disorders . Although this drug causes some mothers to metabolic disorders and causes them to increase greatly, but does not seem to harm the child.
For sleep disorders, the antidepressant amitriptyline can be used as an alternative to diazepam in pregnancy . Although this drug has effects on the fetus, these are less critical than diazepam.
Source: Information on Diazepam on embryotox.de (a project of the Charité Berlin)