Survey among SOAP membership on the use of benzodiazepines during pregnancy, labor and c-section
Author Block
AUTHORS: L. Hebbar, M. Bamert, K. Coyle;
AFFILIATION:MUSC, Charleston, SC.
Abstract:
Introduction: Most information about the effect of benzodiazepines (BZ) on the developing fetus has been based on retrospective studies. The current survey was designed to consolidate practices of SOAP members with regards to use of BZ given the controversial and paucity of literature available on this issue during pregnancy, labor and c-section. Chronic use of BZ during pregnancy for depression, especially diazepam has been associated with an increased risk of cleft lip and palate, low birth weight and small head circumference.
1 Other BZ that have been associated with fetal birth anomalies include chlordiazepoxide, clonazepam and lorazepam.
1 Methods: A total of 764 surveys were mailed out to the SOAP members. The questionnaire included details about the number of deliveries per year, use of BZ for non-obstetric surgery during the first, second and third trimester, during labor and c-section and disclosure of risk of BZ administration to patients.
Results: 70% of responders were from practices with over 2000 deliveries per year.
Pregnancy: Percentage of responders who did not administer BZ during the first, second and third trimesters were 76%, 65% and 45% respectively. Midazolam was the common BZ to be used during the first trimester at a dose of 1-2mg. Of the responders who used BZ during the first trimester, 61% did not explain possibility of any fetal risk with use of BZ to the patient.
Labor: 80% of responders did not administer BZ during labor and 90% responders who used it explained the risk of neonatal depression to the parturient. Midazolam was the common BZ to be used during labor at a dose of 1-2mg.
C-section: 75% of responders administered BZ during c-sections 35% of who administered it after birth of baby and 65% were variable in their decision of administering it before or after the birth of the baby.
Discussion: From the responses received it appears that administration of BZ during the first trimester is not acceptable to most obstetric anesthesiologists with a change in practice during the third trimester, and midazolam was the drug of choice to be used by most anesthesiologists. Informing patients about the possible teratogenic risk of midazolam was not considered important in 61% of anesthesiologists who used it during the first trimester. Use of midazolam during labor was not popular, the only indications being anxiety disorder or chronic use of BZ, in which event patients were informed of neonatal depression. Most anesthesiologists used midazolam during c-section though the timing of was variable. Since this is a preliminary report from an on-going survey, a better understanding of obstetric anesthetic practice with respect to the use of BZ in the pregnant will be available on completion of the survey.
Reference: 1. Psychiatric Services, 53:39-49, 2002
:
Author Disclosure Information: L. Hebbar: None.
