Elsevier

The Journal of Pediatrics

Volume 161, Issue 3, September 2012, Pages 448-451
The Journal of Pediatrics

Original Article
Neonatal Benzodiazepines Exposure during Breastfeeding

https://doi.org/10.1016/j.jpeds.2012.03.003Get rights and content

Objective

To assess central nervous system depression and other adverse effects in infants exposed to benzodiazepines through breast milk.

Study design

A prospectively recruited, retrospectively assessed cohort study of mothers who contacted the Motherisk program regarding the safety of benzodiazepines and were invited to participate in a follow-up program regarding the effects of these medications on their infants during lactation.

Results

A total of 124 consenting women participated. Adverse outcomes, specifically sedation, was identified in only 1.6% (2 of 124) of infants and was not associated with benzodiazepine dose, number of hours breastfed, or any demographic trait. Mothers reporting adverse outcomes in themselves (26% [32 of 124]) were more likely to be taking concomitantly a greater number of central nervous system depressants.

Conclusions

This study supports the continued recommendation to initiate breastfeeding while taking benzodiazepines postpartum.

Section snippets

Methods

A self-referred population of mothers who called the Motherisk Program at the Hospital for Sick Children in Toronto, Ontario, between January 2010 and May 2011 for advice regarding the use of benzodiazepines during lactation were contacted for follow-up. Inclusion criteria consisted of women consenting to the follow-up procedure who were able to be reached, were fluent in English, and used benzodiazepines during breastfeeding. For the sake of confidentiality, calls from lactation consultants,

Results

A total of 296 women contacted the Motherisk program concerning the use of benzodiazepines during lactation between January 1, 2010, and May 31, 2011, and 124 women consented to this investigation. Excluded mothers included 35 who did not take benzodiazepines, 23 who either could not recall details surrounding their benzodiazepine use or refused to participate, and 14 women who did not choose to breastfeed. There were 52 women that could not be reached and 48 telephone numbers that were no

Discussion

The primary objective of the present study was to develop a better understanding of the safety and pharmacodynamics of infant exposure to benzodiazepines during lactation. We detected only 2 cases of sedated infants, and overall, there were no serious adverse drug reactions in participating mothers and children. In both sedated infants, mothers used drugs that are not among the most commonly prescribed in this class: alprazolam and flurazepam combined with clonazepam. There were no significant

References (21)

  • A. Buist et al.

    Breastfeeding and the use of psychotropic medication: a review

    J Affect Disord

    (1990)
  • E. Spina et al.

    Clinically relevant pharmacokinetic drug interactions with second-generation antidepressants: an update

    Clin Therap

    (2008)
  • V.K. Burt et al.

    The use of psychotropic medication during breast-feeding

    Am J Psychiatry

    (2001)
  • Breastfeeding and the use of human milk

    Pediatrics

    (2005)
  • M. Boland

    Exclusive breastfeeding should continue to six months

    Paediatr Child Health

    (2005)
  • A. Einarson et al.

    Abrupt discontinuation of psychotropic drugs during pregnancy: fear of teratogenic risk and impact of counselling

    J Psychiatry Neurosci

    (2001)
  • M.M. Iqbal et al.

    Effects of commonly used benzodiazepines on the fetus, the neonate, and the nursing infant

    Psychiatric Serv

    (2002)
  • C.S. Birnbaum et al.

    Serum concentrations of antidepressants and benzodiazepines in nursing infants: a case series

    Am Acad Pediatr

    (1999)
  • T.W. Hale

    Medications and mothers' milk

    (2004)
  • K. Ito et al.

    Classification of benzodiazepine hypnotics in humans based on receptor occupancy theory

    J Pharmacokinet Biopharm

    (1993)
There are more references available in the full text version of this article.

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Supported by the Ivey Chair in Molecular Toxicology at the University of Western Ontario. L.K. and P.M. are funded by the Canadian Pharmacogenomics Network for Drug Safety and the Canadian Institutes of Health Research. The authors declare no conflicts of interest.

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