Is Concomitant Use of Antidepressants, Benzodiazepines During Pregnancy Safe?

The concomitant use of antidepressants and benzodiazepines during the first trimester of pregnancy is not associated with an elevated risk for congenital malformations or heart defects, according to study results published in Lancet Psychiatry.

Although many pregnant individuals are co-administered antidepressants and anxiolytic medications, relatively little is known about the organ-specific congenital malformation risks associated with the concomitant use of these medications during pregnancy. To address this knowledge gap, investigators conducted a population-based cohort study in Taiwan to evaluate the risk for congenital malformations following first-trimester use of antidepressants and benzodiazepines.

The investigators used data from national databases in Taiwan to identify pregnant individuals aged 15 to 50 years who gave birth between January 1, 2004, and December 31, 2018. Using medical claims data, the investigators compared an exposed cohort of individuals who had overlapping prescriptions for antidepressants and benzodiazepines during the first trimester of pregnancy with an unexposed cohort who did not have any prescriptions for either medication during pregnancy. The primary outcomes of interest were overall major congenital malformations and 8 organ-specific (ie, heart, respiratory system, oral cleft, digestive system, urinary system, genital system, and limbs) malformations.

The investigators identified 2,634,021 singleton pregnancies during the study period. Overall, 8599 (0.3%) pregnant individuals had concomitant use of antidepressants and benzodiazepines during pregnancy. The exposed cohort was more likely to be older and have psychiatric disorders, comorbid medical conditions, and unhealthy lifestyles, relative to the unexposed group.

The unadjusted risk for overall congenital malformations was 3.81 per 100 pregnancies among individuals in the exposed cohort compared with 2.87 per 100 pregnancies in the unexposed cohort. After controlling for covariates using propensity score fine stratification weighting, the investigators did not observe a significantly increased risk for overall malformations (weighted odds ratio [OR], 1.10; 95% CI, 0.94-1.28) or heart defects (weighted OR, 1.01; 95% CI, 0.83-1.23). Additionally, there were not significantly elevated risks for any other organ-specific malformations, with the exception of digestive system malformations (weighted OR, 1.63; 95% CI, 1.06-2.51).

Subgroup analysis further confirmed that both long-term and short-term concomitant use of antidepressants and benzodiazepines did not increase the risk of congenital malformations or heart defects. Further, the risk for congenital malformations was not significantly elevated among women who took either an antidepressant or a benzodiazepine in the first trimester of pregnancy.

“The concomitant use of antidepressants and benzodiazepines during pregnancy does not significantly increase the risk of overall congenital malformations, suggesting they can be used during pregnancy under careful consideration,” the investigators concluded. However, the investigators noted that the “observed association with digestive system defects warrants further investigation.”

The primary study limitation includes the reliance on prescription data to determine concomitant use of antidepressants and benzodiazepines, which may not accurately reflect medication adherence.

This article originally appeared on Psychiatry Advisor