Benzodiazepine Use During Pregnancy Alone or in Combination With an Antidepressant and Congenital Malformations: Systematic Review and Meta-Analysis

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Overview

Is prenatal benzodiazepine use or concurrent use of an antidepressant associated with increased risk of congenital malformations? Read this CME for more.


Read the whole article at psychiatrist.com here:
Benzodiazepine Use During Pregnancy Alone or in Combination With an Antidepressant and Congenital Malformations: Systematic Review and Meta-Analysis

© Copyright 2019 Physicians Postgraduate Press, Inc.

Target Audience

Psychiatrists

Learning Objectives

Use caution when prescribing benzodiazepine-antidepressant combinations to pregnant women, as there may be an increased risk of congenital malformations

Activity summary
Available credit: 
  • 1.00 AMA PRA Category 1 Credit™
  • 1.00 Participation
Activity opens: 
06/21/2019
Activity expires: 
08/30/2021
Cost:
$10.00
Rating: 
0

CME Background

Articles are selected for credit designation based on an assessment of the educational needs of CME participants, with the purpose of providing readers with a curriculum of CME articles on a variety of topics throughout each volume. Activities are planned using a process that links identified needs with desired results.

CME Objective

After studying this article, you should be able to:

  • Use caution when prescribing benzodiazepine-antidepressant combinations to pregnant women, as there may be an increased risk of congenital malformations

Statement of Need and Purpose

Anxiety and depression are prevalent during pregnancy and are associated with adverse pregnancy outcomes, but treatment with benzodiazepines and antidepressants may pose risks as well. Clinical practice guidelines too often were not specifically developed for pregnant women. Clinicians have reported a lack of information as the greatest barrier to counseling pregnant women about medication use. Consequently, clinicians need education on evidence regarding the use of medications for anxiety and depression during pregnancy.

Release, Expiration, and Review Dates

This educational activity was published in July 2019 and is eligible for AMA PRA Category 1 Credit™ through August 31, 2021. The latest review of this material was June 2019.

Disclosure of off-label usage

The authors have determined that, to the best of their knowledge, alprazolam is approved by the US Food and Drug Administration for the treatment of anxiety but should be discontinued during pregnancy and lactation; citalopram and fluoxetine are approved for the treatment of depression and should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

Author contributions

Dr Grigoriadis conceptualized and designed the study and, with Dr Graves, obtained funding, directed data acquisition and analysis, and interpreted the data. Dr Grigoriadis is accountable for all aspects of the work and is the guarantor. Drs Grigoriadis and Peer drafted the manuscript. Dr Peer had substantial roles in data acquisition, data analysis, and drafting and revising the manuscript and with interpretation. Drs Vigod, Dennis, Steiner, Brown, Cheung, Rector, and Richter and Ms Dawson substantially contributed to study design and interpretation. Ms Mamisashvili had substantial role in data acquisition. Drs Grigoriadis, Graves, and Peer had full access to all of the data in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis. All authors reviewed the manuscript critically and approved the final version.

Funding/support

This study was funded by the Canadian Institutes of Health Research, Ottawa, Ontario, Canada (FRN 141002).

Role of the sponsor

The funder of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report.

Previous presentation

A version of this paper was presented at the Canadian Psychiatric Association Conference, September 29, 2018, Toronto, Ontario, Canada.

Faculty Affiliation

Sophie Grigoriadis, MD, PhD*
Mood and Anxiety Disorders Clinic: Reproductive Transitions, Department of Psychiatry, Sunnybrook Health Sciences Centre and the University of Toronto, Toronto, Ontario, Canada

Lisa Graves, MD
Department of Family and Community Medicine, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, Michigan

Miki Peer, PhD
Evaluative Clinical Sciences, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada

Lana Mamisashvili, MSW
Evaluative Clinical Sciences, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada

Cindy-Lee Dennis, PhD
Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada

Simone N. Vigod, MD
Department of Psychiatry, Women’s College Hospital and the University of Toronto, Toronto, Ontario, Canada

Meir Steiner, MD
Department of Psychiatry and Behavioural Neurosciences, St Joseph’s Healthcare Hamilton and McMaster University, Hamilton, Ontario, Canada

Cara Brown, MD
Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada

Amy Cheung, MD
Department of Psychiatry, Sunnybrook Health Sciences Centre and the University of Toronto, Toronto, Ontario, Canad

Hiltrud Dawson, RN
Health Nexus, Toronto, Ontario, Canada

Neil Rector, PhD
Department of Psychiatry, Sunnybrook Health Sciences Centre and the University of Toronto, Toronto, Ontario, Canad

Melanie Guenette, MSc
Division of Neurology, St Michael’s Hospital, Toronto, Ontario, Canada

Margaret Richter, MD
Department of Psychiatry, Sunnybrook Health Sciences Centre and the University of Toronto, Toronto, Ontario, Canada

*Corresponding author: Sophie Grigoriadis, MD, PhD, Women’s Mood and Anxiety Clinic: Reproductive Transitions, Department of Psychiatry, Sunnybrook Health Sciences Centre, FG 29, 2075 Bayview Ave, Toronto, Ontario, M4N 3M5, Canada (sophie.grigoriadis@sunnybrook.ca).

Financial Disclosure

All individuals in a position to influence the content of this activity were asked to complete a statement regarding all relevant personal financial relationships between themselves or their spouse/partner and any commercial interest. The CME Institute has resolved any conflicts of interest that were identified. In the past year, Marlene P. Freeman, MD, Editor in Chief of The Journal of Clinical Psychiatry, has received research funding from JayMac and Sage; has been a member of the advisory boards for Otsuka, Alkermes, and Sunovion; has been a member of the Independent Data Safety and Monitoring Committee for Janssen; and, as a Massachusetts General Hospital (MGH) employee, works with the MGH National Pregnancy Registry, which is sponsored by Teva, Alkermes, Otsuka, Actavis, and Sunovion, and works with the MGH Clinical Trials Network and Institute, which receives research funding from multiple pharmaceutical companies and the National Institute of Mental Health. No member of the CME Institute staff reported any relevant personal financial relationships.

Dr Grigoriadis has received personal fees from UpToDate, Eli Lilly, Psychotherapy Essentials to Go, and Compendium of Pharmaceuticals and Specialties over the last year, outside the submitted work, and Dr Vigod has received personal fees from UpToDate outside the submitted work; there are no other relationships or activities that could appear to have influenced the submitted work. Drs Graves, Peer, Dennis, Steiner, Brown, Cheung, Rector, and Richter and Mss Mamisashvili, Dawson, and Guenette have no personal affiliations or financial relationships with any commercial interest to disclose relative to the article.

Accreditation Statement

The CME Institute of Physicians Postgraduate Press, Inc., is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Credit Designation

The CME Institute of Physicians Postgraduate Press, Inc., designates this journal-based CME activity for a maximum of 1.00 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Note: The American Nurses Credentialing Center (ANCC) and the American Academy of Physician Assistants (AAPA) accept certificates of participation for educational activities certified for AMA PRA Category 1 Credit™ from organizations accredited by the ACCME.

Available Credit

  • 1.00 AMA PRA Category 1 Credit™
  • 1.00 Participation

Price

Cost:
$10.00
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