Department of Psychiatry, Erasmus University Medical Centre Rotterdam, Rotterdam, the Netherlands.
Department of Psychiatry, Erasmus University Medical Centre Rotterdam, Rotterdam, the Netherlands; Icahn School of Medicine at Mount Sinaï, New York, United States.
J Affect Disord. 2020 May 15;269:18-27. doi: 10.1016/j.jad.2020.03.014. Epub 2020 Mar 5.
Maternal use of benzodiazepines during pregnancy is common and has increased over the last decades. In this systematic review and meta-analysis, we studied the literature to estimate the worldwide use of benzodiazepines before, during and after pregnancy, which could help to estimate benzodiazepine exposure and to prioritize and guide future investigations.
We systematically searched Embase, Medline Ovid, Web of Science and Cochrane Central up until July 2019 for studies reporting on benzodiazepine use before (12 months), during and after pregnancy (12 months). Random effects meta-analysis was conducted to calculate pooled prevalence estimates, as well as stratified according to substantive variables.
We identified 32 studies reporting on 28 countries, together reporting on 7,343,571 pregnancies. The worldwide prevalence of benzodiazepine use/prescriptions during pregnancy was 1.9% (95%CI 1.6%-2.2%; I 97.48%). Highest prevalence was found in the third trimester (3.1%; 95%CI 1.8%-4.5%; I 99.83%). Lorazepam was the most frequently used/prescribed benzodiazepine (1.5%; 95%CI 0.5%-2.5%; I 99.87%). Highest prevalence was found in Eastern Europe (14.0%; 95%CI 12.1%-15.9%; I 0.00%).
All analyses revealed considerable heterogeneity.
Our meta-analysis confirmed that benzodiazepine use before, during and after pregnancy is prevalent. The relatively common use of benzodiazepines with possible risks for both mother and (unborn) child is worrying and calls for prescription guidelines for women, starting in the preconception period. Given the substantial proportion of children exposed to benzodiazepines in utero, future research should continue to study the short- and long-term safety of maternal benzodiazepine use during pregnancy and to explore non-pharmacological alternative treatments.
孕妇在孕期使用苯二氮䓬类药物较为常见，且在过去几十年中呈上升趋势。在本系统评价和荟萃分析中，我们对文献进行了研究，以估计全球范围内妊娠前、妊娠中和妊娠后苯二氮䓬类药物的使用情况，这有助于估计苯二氮䓬类药物的暴露情况，并为未来的调查提供优先顺序和指导。
我们系统地检索了 Embase、Medline Ovid、Web of Science 和 Cochrane Central，截至 2019 年 7 月，以获取报告妊娠前（12 个月）、妊娠期间（12 个月）和妊娠后苯二氮䓬类药物使用情况的研究。采用随机效应荟萃分析计算了汇总的流行率估计值，并根据实质性变量进行了分层分析。
我们确定了 32 项研究，涉及 28 个国家，共报告了 7343511 例妊娠。全球范围内，妊娠期间使用/处方苯二氮䓬类药物的流行率为 1.9%（95%CI 1.6%-2.2%；I 97.48%）。最高的流行率见于妊娠晚期（3.1%；95%CI 1.8%-4.5%；I 99.83%）。劳拉西泮是最常使用/开处的苯二氮䓬类药物（1.5%；95%CI 0.5%-2.5%；I 99.87%）。东欧的流行率最高（14.0%；95%CI 12.1%-15.9%；I 0.00%）。
所有分析均显示出相当大的异质性。
我们的荟萃分析证实，妊娠前、妊娠中和妊娠后使用苯二氮䓬类药物较为普遍。母亲和（未出生的）孩子都可能面临风险，这种相对常见的苯二氮䓬类药物的使用令人担忧，需要在孕前为女性制定处方指南。鉴于在子宫内暴露于苯二氮䓬类药物的儿童比例较大，未来的研究应继续研究母亲在妊娠期间使用苯二氮䓬类药物的短期和长期安全性，并探索非药物替代治疗方法。
