Benzodiazepines and Pregnancy: Understanding the Risks

Benzodiazepines are a class of prescription drugs primarily prescribed to manage anxiety and panic disorders, seizures, and sleep issues.¹ Women who are pregnant or considering becoming pregnant may need benzodiazepines to manage their health during their pregnancy but may be concerned about how the medication can impact their developing baby.²

Studies show that there are risks associated with using benzodiazepines during pregnancy which may warrant caution. In some cases, however, stopping a benzodiazepine before or during pregnancy may be more harmful than taking the medication.^{1, 2}

If you are pregnant or considering becoming pregnant and taking benzodiazepines, it’s important to speak with your doctor. They can help determine a treatment plan to keep you and your developing baby healthy.²

Benzodiazepines and Pregnancy

Benzodiazepines are central nervous system (CNS) depressants that produce calming, sedative effects. Common benzodiazepines include:³

• Xanax (alprazolam)
• Valium (diazepam)
• Klonopin (clonazepam)
• Ativan (lorazepam)
• Restoril (temazepam)

Benzodiazepines can be safe and effective when taken as prescribed by a doctor for short periods, and use is typically limited to 4 weeks or less. Longer-term, regular use of benzodiazepines can result in tolerance (needing increasing amounts to get the same effect), and dependence which is characterized by experiencing withdrawal symptoms, even if the medication is taken as prescribed by a doctor.⁴ Unfortunately, people can misuse benzodiazepines in several ways, such as by taking someone else’s prescription or taking them in a way other than prescribed (e.g., snorting, or taking a larger dose), or using them intentionally to amplify certain effects of other drugs, (e.g., opioid) or to stave off symptoms of withdrawal from other substances (e.g., cocaine).⁵

The Food and Drug Administration (FDA) labels for benzodiazepines warn patients to talk to their doctors about the use of benzodiazepine, as there is some evidence of adverse outcomes when taken during pregnancy or while breastfeeding. However, these risks are generally considered minimal, and there may be benefits that warrant the use of benzodiazepines during pregnancy, despite the potential risks.¹

What Are the Risks of Using Benzodiazepines During Pregnancy?

In research cited by the Centers for Disease Control, fewer than 1 in 100 women took benzodiazepines during pregnancy. Studies show that taking benzodiazepines in pregnancy may be associated with an increased risk of certain adverse perinatal outcomes when compared with women who did not use benzos while pregnant, including:^{2, 6, 7}

• Preterm delivery.
• Respiratory distress syndrome.
• Low Apgar scores (a newborn health assessment).
• Low birth weight.
• Neonatal Intensive Care Unit (NICU) admissions.

Despite a small increase in risk, the overall risk for birth defects is still quite low.² It is important to note that researchers don’t know if the risk for birth defects is linked to using benzodiazepines during pregnancy or to the underlying conditions the medicines are prescribed to treat.² Stress and anxiety during pregnancy are associated with risks also, including spontaneous abortion, preterm delivery, and delivery complications.⁷ Thus, there may be benefits that warrant the use of benzodiazepines during pregnancy.¹

Furthermore, advising pregnant women to stop taking benzodiazepines may create new risks associated with inadequately treated or untreated mental health conditions, such as:⁷

• Poor adherence to prenatal care.
• Poor nutrition.
• Alcohol and/or tobacco use.

It’s important to contact your doctor if you are pregnant or considering pregnancy and are currently taking benzodiazepines. Stopping benzodiazepines without medical guidance is not advised.⁸ Your doctor can best advise you on keeping you and your developing baby as safe as possible.

Benzodiazepines and Breastfeeding

Around 60% of mothers do not breastfeed for as long as they intend to for several reasons, one of which is concerns about taking medications.⁹ The U.S. Food and Drug Administration (FDA) has issued several rules on drug labeling to provide breastfeeding mothers with clearer instructions and risks. Still, little is known about the effects of many medications on breastfeeding.⁹

Psychotropic medications cross the placenta and can enter breast milk. FDA labels for different benzodiazepines warn against breastfeeding while taking the medications as infants may experience sedation and other effects that impact feeding.⁷ However, the expected benefit for the mother may outweigh the minimal risk of CNS depression in the child, which is why it’s important to talk to your doctor if you plan to breastfeed while taking benzodiazepines.^{10, 11}

Tips for Coping with Anxiety During Pregnancy

Being pregnant is an exciting time but can also feel isolating and overwhelming. If you are pregnant and struggling with anxiety, there are several things you can do to help manage your stress, such as:¹²

• Eating a healthy diet.
• Avoiding caffeine.
• Getting enough sleep.
• Exercising.
• Stretching.
• Meditation.
• Journaling.
• Talking to family and friends.
• Reaching out for help from a professional if you need it.

Polysubstance Use and Pregnancy

Benzodiazepine misuse often occurs in conjunction with the misuse of other substances—most commonly with alcohol or opioids—both of which can have health effects on a pregnant woman and their developing baby.^{13, 14} Alcohol use during pregnancy can cause miscarriage, stillbirth, various birth defects, and developmental disabilities. Opioid use during pregnancy can cause preterm birth and stillbirth, as well as neonatal abstinence syndrome (NAS) or neonatal opioid withdrawal syndrome (NOWS).^{13, 14}

In general, polysubstance use can increase your risk of physical and mental health problems, including overdose and death, so getting the care and support you need is important.¹³

Getting Help for Benzodiazepine Misuse

If you are pregnant or considering becoming pregnant and think you may have a problem with benzodiazepines, it’s okay to ask for help. Benzodiazepine addiction treatment options are available and can help keep you and your baby safe.

Recovery looks different for everyone, but many patients who enter rehab for benzodiazepine misuse begin treatment with medical detox. Because benzodiazepine withdrawal symptoms can be dangerous, medical detox can help patients achieve a substance-free state while under the care and supervision of medical professionals.¹⁵

Detox alone is not typically sufficient in helping patients achieve long-term abstinence. Following detox, transitioning to ongoing treatment in an inpatient or outpatient setting can help patients modify their behaviors and thinking and learn healthy ways to manage stress without the use of benzodiazepines.¹⁶

Finding Benzodiazepine Addiction Rehab

You have several options when it comes to rehab programs for pregnant mothers. In addition to evidence-based treatment, rehab programs may provide specialized support, such as family therapy, pregnancy counseling and education, prenatal care, and more.

If you aren’t sure where to start, American Addiction Centers (AAC) is here to help. You can call to speak with an admissions navigator who can answer questions you have about treatment, help you find treatment near you, and connect you with local resources.