(134) Benzodiazepine prescription during pregnancy and factors associated with sedative use disorder.

Objective:
Benzodiazepines (BZD) are frequently prescribed during pregnancy despite lacking efficacy for treating mental health disorders and unfavorable safety profile.  Since they are increasingly involved in overdose-related deaths, we aimed to characterize BZD prescribing patterns and risks for sedative use disorder.

Study Design:
We conducted a retrospective cohort study of all patients who received prescription BZD during pregnancy and delivered >20 weeks’ gestation at a tertiary care center from January 2014 to June 2024. Patients were excluded if they received BZD only in the context of peri-procedural anesthesia. Medical records were extracted for sociodemographic and delivery characteristics. International Disease Classification codes identified patients with a coded diagnosis of sedative use disorder and conditions such as seizure, mental health, and substance use disorders. Groups were compared using chi-square and Fisher’s Exact test. Log binomial regression was used to generate risk ratios (RR) and 95% confidence intervals (CI). A p< 0.05 was considered significant.

Results:
During the study period, 568 deliveries occurred to 537 patients. Alprazolam (36.1%), diazepam (28.9%), and clonazepam (25.4%) were the most prescribed BZD. Sedative use disorder was identified in 23 (4.0%) of deliveries. Those with sedative use disorder were more likely to have a prescription for alprazolam (56.5% vs 34.3%, p=0.03), diagnosis of other substance use disorder (82.6% vs 19.4%, p< 0.001), and diagnosis of any mental health condition (95.7% vs 74.7%, p=0.02). There was no difference in diagnosis of seizure disorder. Patients with opioid use disorder who are prescribed BZD are more likely to have a diagnosis of sedative use disorder (RR 16.1; 95% CI: 6.5, 39.5). There remained 9-fold increased risk after adjusting for other substance use and mental health disorders (aRR 9.1; 95% CI: 3.4, 24.6).

Conclusion:
 

It is important to evaluate for sedative use disorder among patients prescribed BZDs during pregnancy, particularly those prescribed alprazolam or with co-existing opioid use disorder.