Prospective assessment of pregnancy outcome: DISCUSSION
Recently Laegreid and colleagues reported abnormal growth and neurodevelopment of 17 children born to mothers who used BDZ in therapeutic doses as their only psychotropic drug in pregnancy. Gross motor development that was slow at six and 10 months normalized by 18 months, and fine motor functions were found to be impaired on all study occasions. Infants attained developmental milestones, as defined by the Denver Developmental Scale (age at first smile, lifting of head, unaided sitting, crawling, standing, speaking, walking), at the appropriate ages (Table 7). Such discrepancy between these two studies may reflect that the patients in the Gothenbrug study constantly used high doses of BDZ (eg, 75 to 105 mg oxazepam/ day and 30 mg diazepam/ day) whereas women counselled by Motherisk used relatively low doses of various BDZs. If geographic differences within the same country demonstrate striking differences in intake habits of BDZ during pregnancy, one can only imagine how difficult it would be to relate such conclusions to an entirely different group of patients, who most likely represent the ‘typical’ user of BDZ. buy asthma inhaler
Our results are more similar to those of a study by Bergman et al, who used the Michigan Medicaid database to establish that 50 of 64 live born infants (78%) whose mothers received no more than 10 BDZ prescriptions throughout pregnancy showed no develop men tal abnormalities. Only eight infant records were consistent with developmental teratogenicity. This study, however, was a computerized retrieval of health claims files and did not incorporate validation of medical records or contact with patients or physicians. One must assume that prescription documentation reflects drug ingestion. Strengths of our study include the fact that patients reported drug exposure soon after starting therapy and that infant outcome and health status were corroborated by physician reports (and, in some cases, by neonat al ass essment forms). The telephone interview and written report are not as rigorous as a medical examination would have been, but there is no objective confirmation of BDZ use.
Since BDZs are lipid-soluble and highly protein-bound, their elimination from the newborn infant is slow due to immaturity of liver metabolism. In addition, it is possible that increased serum BDZ concentrations and an immature blood-brain bar rier may in crease neo na tal sen sitiv ity to these compounds.
Tags: Benzodiazepines, Fetus, Pregnancy