孕期和哺乳期的苯二氮卓类药物使用的影响。

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McElhatton公关

孕期和哺乳期的苯二氮卓类药物使用的影响。

天线转换开关Toxicol。1994; 11 - 12月8 (6):461 - 75。

PubMed ID
7881198 (在PubMed
]
文摘

虽然有许多研究和个案报告有关使用苯二氮平类药物在人类怀孕、产后发展有关致畸性和影响的资料和行为不一致。有证据表明从研究在1970年代,前三个月在子宫内暴露于苯二氮卓类导致一些婴儿的诞生与面部结晶,心脏畸形,和其他多种畸形,但没有缺陷的综合症。安定、利眠宁药物中最常涉及的早期研究。然而,后来的研究提供的数据没有明确的证据显示多显著增加的总体发病率畸形或任何特定类型的缺陷。许多女性在这些研究包括精神疾病,癫痫,或糖尿病怀孕,所有这些都有一个内在的风险和一些耐多药治疗。Medical-obstetric历史和畸形家族史并不总是在出版物,这使得风险评估与使用苯二氮本身困难有关。然而,在大多数的研究涉及妊娠前三个月使用苯二氮卓类,大多数婴儿在出生时是正常的,产后正常发展。晚期妊娠后期使用和暴露在工党似乎与胎儿或新生儿更大的风险。一些,但并非所有婴儿暴露在这个时候,展览软盘婴儿综合症,或新生儿戒断症状。症状从轻度镇静、张力减退和不愿吸,apnoeic法术,黄萎病,受损的代谢对冷应激的反应。 These symptoms have been reported to persist for periods from hours to months after birth. This correlates well with the pharmacokinetic and placental transfer of the benzodiazepines and their disposition in the neonate. However, there has been no significant increase in the incidence of neonatal jaundice and kernicterus in term infants. The prolonged use of benzodiazepines throughout pregnancy raised the concern that there may be altered transmitter synthesis and function, leading to neurobehavioural problems in the children. In approximately 550 children who were followed up for various times up to four years of age, there is no increase in either the malformation rate or adverse effects on neurobehavioural development and IQ. Although some of the data indicate that a small number of children were slower to develop during the first year or so, they did exhibit catch up growth and most had developed normally by four years of age. Where developmental deficits persisted, it was not possible to prove a cause-effect relationship with benzodiazepine exposure. These children were often from families where there was maternal illness requiring prolonged drug therapy or where there were social problems. It is important to consider poor environmental and social factors when assessing the possible prenatal influence of the benzodiazepines on the postnatal health and development of the child. There is evidence that clonazepam, clorazepate, diazepam, lorazepam, midazolam, nitrazepam, and oxazepam are excreted into breast milk. The published data indicate that the levels detected in breast milk are low; therefore, the suckling infant is unlikely to ingest significant amounts of the drug in this way. Problems may arise if the infant is premature or has been exposed to high concentrations of drug either during pregnancy or at delivery.

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