Is Ativan (Lorazepam) Safe During Pregnancy?

What does the evidence say about ativan during pregnancy?

1. It's unlikely that lorazepam significantly increases the overall chance of birth defects, though two individual studies found possible links to specific conditions, anal atresia in one and a heart valve issue called pulmonary valve stenosis in another, that other research hasn't confirmed. 1
2. Newborns exposed to lorazepam late in pregnancy can have temporary symptoms such as irritability, crying, sleep disturbances, tremors, jitteriness, trouble breathing, or muscle weakness, though not every exposed baby develops these, and when they occur they typically resolve within a few weeks with no known long-term effects. 2
3. In a Finnish cohort of 6,231 first-time mothers, the 3.2 percent who purchased a sedative or benzodiazepine-related medication during the study window did not have a significantly higher rate of preterm birth, 5.6 percent versus 6.3 percent, or low birth weight, though NICU care was numerically higher and came close to statistical significance, 17.8 percent versus 11.3 percent. 3
4. Lorazepam passes into breast milk in small amounts. In documented cases, milk levels after a 2.5 mg twice-daily dose totaled about 47 mcg/L with an estimated relative infant dose of roughly 1.35 to 1.8 percent, and a telephone survey of 64 nursing mothers using lorazepam found zero cases of infant sedation. 4
5. A review of pharmacovigilance data found no adverse events attributed to lorazepam alone during breastfeeding, and lorazepam is described as a medication that can be safely given directly to infants in other clinical contexts, while still recommending that breastfeeding parents watch for sedation, poor feeding, or inadequate weight gain in the baby. 4

Is ativan safe in each trimester?

• First trimester. Lorazepam has not been clearly linked to a higher overall birth defect rate in population studies, though isolated reports have raised questions about specific defects, like anal atresia or a heart valve issue, that other research hasn't confirmed.
• Second trimester. Some studies of second-half pregnancy exposure found a higher chance of preterm delivery and lower birth weight, though not every study agreed, and other factors besides lorazepam may explain the difference.
• Third trimester. Exposure close to delivery can cause temporary newborn symptoms such as irritability, tremors, trouble breathing, or muscle weakness, sometimes described as floppy infant syndrome. These typically resolve within a few weeks, and your delivery team should know your dose and timing in advance.