Benzodiazepines & Pregnancy: Safety & Effects on the Baby

Risks of Benzodiazepine Treatment During and After Pregnancy

Most benzodiazepines have a category D rating within the U.S. Food and Drug Administration (FDA) Pregnancy Categories. This means that there is some positive evidence of human fetal risk, but the potential benefits may warrant use of benzodiazepines in pregnant women.¹ There are also several benzodiazepine medications that currently have a category X rating. This means that the risk involved with their use clearly outweigh the potential benefits and they are contraindicated during pregnancy. These drugs include:²

• Flurazepam (Dalmane)
• Estazolam (ProSom)
• Temazepam (Restoril)
• Quazepam (Doral)
• Triazolam (Halcion)

A recent study conducted by the Yale University School of Medicine found that pregnancies with maternal use of benzodiazepines are 2.5 times more likely to result in cesarean delivery (C-section birth) and almost 3 times more likely to result in a need for ventilatory support for the newborn baby.³  Maternal benzodiazepine use during pregnancy has also been shown to be associated with other adverse outcomes such as:^4-7

• Cleft lip and palate
• Preterm birth
• Low birth weight
• Neonatal respiratory distress

All classes of benzodiazepines rapidly cross the placenta and can consequently affect the baby.⁹ Symptoms of benzodiazepine toxicity have been reported in newborns, including sedation, decreased muscle tone (floppiness), and breathing problems.⁹

Neonatal Benzodiazepine Withdrawal

These symptoms are not commonly seen and are likely to occur in women taking higher doses of benzodiazepines. There have also been reports of benzodiazepine withdrawal occurring in newborns exposed to benzodiazepines during pregnancy.¹⁰ Symptoms of neonatal benzodiazepine withdrawal include irritability, sleep disruption, restlessness, depression, tremors, and seizures.¹⁰

Benzodiazepines & Breast Milk

Benzodiazepines are excreted in breast milk, although the levels detected are relatively low.¹¹ A breastfeeding infant is therefore unlikely to ingest significant amounts of the drug in this way. If a mother plans to use benzodiazepines during breastfeeding the baby should be closely monitored for sleepiness, low energy, weight loss, or poor suckling, as these are signs that the baby may be ingesting high levels of the drug.¹²

Treatment Options & Tapering

It is important that women who currently use benzodiazepines and are pregnant, or considering getting pregnant, understand the ways in which a fetus can be affected by exposure to these drugs. It is then up to them and their doctor to decide whether the benefits of benzodiazepine use during pregnancy outweigh any potential risks.

If you are pregnant and suffer from a benzodiazepine addiction, please consider seeking help of addiction specialists to assist in quitting the use of this drug in order to minimize any risks to your baby. Consult your doctor or an addiction specialist today to learn about treatments that can help you overcome a dependence on benzodiazepines.

You should not abruptly discontinue the use of this medication, as this can result in symptoms of withdrawal that can be harmful to your unborn baby. A slow tapering from benzodiazepines is recommended, as this will reduce your risk of experiencing withdrawal symptoms, preterm delivery, and any other adverse outcomes that may occur immediately before and after birth.¹⁰

Sources

1. U.S. Department of Health and Human services. (2019). FDA Pregnancy Categories.
2. Armstrong, C. (2008). ACOG Guidelines on Psychiatric Medication Use During Pregnancy and Lactation. American Family Physician, 78(6), 772-778.
3. Yonkers, K.A., Gilstad-Hayden, K., Forray, A., & Lipkind, H.S. (2017). Association of Panic Disorder, Generalized Anxiety Disorder, and Benzodiazepine Treatment During Pregnancy With Risk of Adverse Birth Outcomes. JAMA Psychiatry, 74(11), 1145-1152.
4. Calderon-Margalit, R., Qiu, C., Ornoy, A., Siscovick, D.S., & Williams, M.A. (2009).  Risk of preterm delivery and other adverse perinatal outcomes in relation to maternal use of psychotropic medications during pregnancy. American Journal of Obstetrics and Gynecology, 201(6), 579.e1-579.e8.
5. Källén, B., & Reis, M. (2012). Neonatal complications after maternal concomitant use of SSRI and other central nervous system active drugs during the second or third trimester of pregnancy. Journal of Clinical Psychopharmacology, 32(5), 608-614.
6. Crump, C., Winkleby, M.A., Sundquist, K., & Sundquist, J.  (2010). Preterm birth and psychiatric medication prescription in young adulthood: a Swedish national cohort study. International Journal of Epidemiology, 39(6), 1522-1530.
7. Wikner, B.N., Stiller, C.O., Bergman, U., Asker, C., & Källén, B. (2007). Use of benzodiazepines and benzodiazepine receptor agonists during pregnancy: neonatal outcome and congenital malformations. Pharmacoepidemiology and Drug Safety, 16(11), 1203-1210.
8. Griffiths, S.K., & Campbell, J.P. (2015). Placental structure, function and drug transfer. Continuing Education in Anesthesia Critical Care & Pain, 15(2), 84-89.
9. Iqbal, M.M., Sobhan, T., & Ryals, T. (2002). Effects of commonly used benzodiazepines on the fetus, the neonate, and the nursing infant. Psychiatric Services, 53(1), 39-49.
10. Shyken, J.M., Babbar, S., Babbar, S., & Forinash, A. (2019). Benzodiazepines in Pregnancy. Clinical Obstetrics and Gynecology, 62(1), 156-167.
11. Tripathi, B.M., & Majumder, P. (2010). Lactating mother and psychotropic drugs. Mens Sana Monographs, 8(1), 83-95.
12. Organization of Teratology Information Specialists. (2017). Mother to Baby: Benzodiazepines.