Ativan is a benzodiazepine and works by increasing availability of the neurotransmitter, gamma-aminobutyric acid (GABA), which calms the central nervous system. When Ativan is consumed, it produces a tranquilizing effect. It is used to treat anxiety, insomnia, restlessness, panic, muscle spasms, and sometimes seizures.
These symptoms can continue into pregnancy, and pregnancy can be a further source of stress and anxiety for some. While it is not safe to take Ativan or other benzodiazepines during pregnancy, there are other classes of medications, as well as non-medication treatments, that can help.
Ativan & Pregnancy
Ativan is the 65th most prescribed drug in the United States and the fourth most prescribed in its class. The drug is clinically proven to treat anxiety, panic, and other similar conditions in which heightened central nervous system activity is debilitating.
However, this drug poses risks to the fetus if taken during pregnancy. Studies show it can increase the potential for birth complications, including malformations of the fetus. All pregnancies carry a 3 to 5 percent chance of birth defects, and this risk increases with the consumption of Ativan.
What the Studies Show
The available research has not established a strong correlation between Ativan and serious complications during pregnancy. However, it is likely that the benefits of Ativan consumption during pregnancy do not outweigh the potential risks involved.
Some research has shown that Ativan consumption during pregnancy is associated with preterm labor and low birth weight, although there are issues with this research that affect the ability to establish a causal link between Ativan and pregnancy complications. These issues include the correlational nature of the research, small sample sizes, and the inability to control for extraneous and confounding variables that may impact the link between Ativan and pregnancy outcomes.
Additionally, Ativan is not recommended during the postnatal period if breastfeeding because of the potential for the drug to change the composition of breastmilk and the potential to induce oversedation in the infant.
What Are the Risks of Taking Ativan During Pregnancy?
Potential risks for the pregnant individual include the following:
- Heavy sedation
- Depression of the respiratory system
- Extremely low heart rate
Additional risks that may exist if consuming Ativan while pregnancy include the following:
- Preterm delivery (delivery before 37 weeks of pregnancy)
- Low birth weight
- Complications during the birthing process
- Damage to the placenta
Side Effects to the Baby
In addition to short-term effects related to birth, many of the potential side effects to the baby from Ativan consumption during pregnancy can result in long-term issues.
For example, according to the Massachusetts General Hospital Center for Women’s Mental Health, Ativan consumption during pregnancy is associated with a slightly higher than average risk of cleft palate and cleft lip in newborns. This outcome is most likely to occur when consuming Ativan during the first half of pregnancy, particularly in the first trimester, when the fetus is in its most vulnerable developmental phase.
Babies of women who consume Ativan during pregnancy may show signs of withdrawal that can include the following:
- Extreme lethargy and sedation
- Problems breathing and extremely slow respiration rate
- Extremely low heart rate
- Poor coordination and a slack, weak, or “floppy” nature
Addiction & Withdrawal
An addiction can be a very challenging situation to manage, and pregnancy can complicate this disorder. If you or someone you know may have an addiction to Ativan, the following signs and symptoms may be present:
- Blurred vision
- Pain or stiffness in the muscles
- Difficult breathing
- Difficulty concentrating
- Impaired relationships
- Social isolation
- Problems at work
- Preoccupation with finding and accessing Ativan
- Continued use of the drug despite negative effects
Discontinuing Ativan following an addiction can produce difficult withdrawal symptoms, such as these:
- Increased blood pressure
- Increased heart rate
- Heart palpitations
- Abdominal cramps
If you’ve been taking benzodiazepines for a while, it’s not safe to stop taking them suddenly. Doing so can lead to life-threatening withdrawal symptoms, such as seizures, and this risk can be compounded during pregnancy.
Talk to a doctor about how to safely stop taking the medication. This will generally involve a tapered withdrawal approach.
When Might a Doctor Prescribe Ativan During Pregnancy?
Ativan is classified as a Class D drug by the Food and Drug Administration, which means that it should not be taken during pregnancy. Therefore, there is likely no situation in which a doctor in the United States would prescribe Ativan to a woman who is pregnant unless the risks to the mother’s mental health are so severe that its consumption is necessary for the woman or the infant’s survival.
For example, if a woman is experiencing extreme panic and self-harming behavior and no safe alternative is available, Ativan may be prescribed acutely. This situation is unlikely, however, and it’s more likely that another medication option will be used that is deemed safer during pregnancy.
Safe Alternatives to Treat Anxiety During Pregnancy
Selective serotonin reuptake inhibitors (SSRS) are commonly prescribed as safe alternatives to Ativan for women who are pregnant. There are also natural alternatives that have been proven to be effective for reducing anxiety, including these:
- Aromatherapy: The use of scented oils or candles (such as lavender) can produce a calming effect.
- Cognitive behavioral therapy: This is a form of psychoeducation and therapy that trains you to think more productively and realistically to control emotions and behaviors.
- Massage: Physical manipulation of the tissues can produce muscular and psychological relaxation.
- Meditation: This is a practice of relaxed and concentrated breathing that has been shown to increase blood and oxygen flow to the brain and activate the parasympathetic nervous system to reduce anxiety.
- Cardiovascular exercise: Exercise can produce endorphins and regulate neurotransmitter production, which generally improve the health of the circulatory and musculoskeletal systems.
- Support groups: Group therapy and support groups can be vital resources during pregnancy. As people share their experiences with each other, participants can feel less alone, and this can help to reduce anxiety during pregnancy.
- Benzodiazepines and Pregnancy. (March 219). Clinical Obstetrics and Gynecology.
- How to Treat Anxiety Symptoms During Pregnancy. (December 2007). MGH Center for Women’s Mental Health.
- Lorazepam: Drug Usage Statistics, United States, 2013-2020. (September 2021). ClinCalc.
- Pregnancy Outcomes in Women Exposed to non-Valium Benzodiazepines. (1995). Reproductive Toxicology.
- Effects of Commonly Used Benzodiazepines on the Fetus, the Neonate, and the Nursing Infant. January 2002). Psychiatric Services.
- First-Trimester Exposure to Benzodiazepines and Risk of Congenital Malformations in Offspring: A Population-Based Cohort Study in South Korea. (March 2022). PLOS ONE.
- Ativan. U.S. Food & Drug Administration.