Ativan During Pregnancy & Breastfeeding

by on April 21, 2012

Can pregnant women take Ativan?

Ativan use during pregnancy is generally unsafe. Benzodiazepines such as Ativan (Lorazepam) are known to cause harm on the unborn child and therefore must be avoided during pregnancy.

The FDA classifies Ativan as a Pregnancy Category D medication. This means that there is clear evidence of the possible risk to the unborn child. Based on animal studies, Ativan increases the risk for birth defects and miscarriages. However, drugs falling under Pregnancy Category D may still be taken by a pregnant woman if the perceived benefits outweigh the potential risks. For instance, in case of life-threatening conditions such as status epilepticus (prolonged seizure) and there are no available options, Ativan may be given to the pregnant woman.

Current research is inconclusive, but taking lorazepam during the first trimester of pregnancy may increase the chance of malformations, reduced IQ, and developmental delays.  There are reported cases of infants born to mothers who have taken benzodiazepines during the late phase of pregnancy or hours prior to delivery exhibiting withdrawal symptoms. Some of the reported symptoms include decreased activity, difficulty breathing or shallow breathing, sudden cessation of breathing, feeding problems, abnormally low temperature, decreased muscle tone, and problem dealing with cold stress.  These effects may last a few hours after birth or until the infant is a few months old.

These symptoms must be monitored carefully to prevent possible harm on the infant. A specific animal study suggests that taking lorazepam doses of 20 to 36 mg/kg may result in cleft palate (incomplete closure of the upper lip and roof of the mouth).

Before you start taking Ativan, make sure that you discuss with your healthcare provider any plans of getting pregnant. If you become pregnant while on Ativan treatment, contact your healthcare provider right away. Your healthcare provider must consider the possible benefits and risks of taking Ativan during pregnancy before giving any recommendation.

Can breastfeeding women take Ativan?

Previous studies suggest that Ativan is excreted into breastmilk in small amounts. Because of the possible serious side effects on the nursing infant, Ativan is not normally recommended to breastfeeding patients. The manufacturers recommend that this medication be used by breastfeeding women only when there is a clear need and when the benefits outweigh the potential risks.

A potentially serious side effect of Ativan use is sedation but has not been reported. The American Academy of Pediatrics says that although the effect of Ativan on the nursing infants is unknown, it can be of concern. There are some reports claiming that infants of breastfeeding mothers exhibit negative effects such as poor feeding and sedation. Infants exposed to benzodiazepines through the breast milk must be carefully monitored for unwanted pharmacological effects.

Inform your healthcare provider if you are breastfeeding and have been prescribed Ativan. Your healthcare provider must consider the possible benefits and risks of taking Ativan during pregnancy before giving any recommendation. Depending in your situation, your healthcare provider may recommend continuing the drug and stopping breastfeeding or changing the drug. You and your healthcare provider will come up with a shared decision that best suits your situation.