Using benzodiazepines during late-term pregnancy can increase the risk of side effects in your baby, but each mother should weigh the benefits and risks with their doctor.

Article at a Glance:

Benzodiazepines formerly carried a Category D rating in the U.S. Food and Drug Administration (FDA) Pregnancy Categories.

The drugs can cause sedation and withdrawal symptoms in a baby after birth.

Benzodiazepines were formerly believed to increase the risk of malformations like cleft palate. However, newer studies do not show an apparent increased risk of malformations, so the relationship is unclear.

Benzodiazepines and Pregnancy

Benzodiazepines can include medications such as Klonopin (clonazepam), Xanax (alprazolam), Ativan (lorazepam), and Valium (diazepam). Most doctors strongly discourage taking benzos during pregnancy because of the risk of sedation and withdrawal in a baby.

If you are using any of these medications and become pregnant, schedule a meeting with your doctor. Ideally, you should consult your psychiatrist or obstetrician before you attempt to conceive or if you are sexually active and do not use birth control.

What We Know About Maternal Use of Benzodiazepines

Benzodiazepines formerly carried a Category D rating in the U.S. Food and Drug Administration (FDA) Pregnancy Categories. A Category D rating meant that there is evidence of risk to a baby. This rating was largely due to older studies that indicated that benzodiazepine use in pregnancy may increase the risk of fetal malformations like cleft palate.

However, the FDA started to change its pregnancy rating system in 2014, removing the old pregnancy categories. This coincided with more studies being done on benzodiazepines in pregnant women. These newer studies showed that there is not a clear link between benzodiazepine use and fetal malformation. Further, the Centers for Disease Control and Prevention (CDC) notes that any increased risk for fetal malformations may not be due to a benzodiazepine but instead to the mother’s medical condition that the benzodiazepine is used to treat.

Benzodiazepine use is still noted to carry risks to an unborn baby, however, especially when they are taken in the late third trimester.

Effects Of Benzo Use on the Unborn Baby

If a pregnant woman is using benzodiazepines, the fetus may be at risk for side effects.

Remember, benzodiazepines are prescription medications that should only be used with a prescription from a doctor. Do not take this medication if you have not been diagnosed with an anxiety disorder.

Adverse Outcomes

Adverse outcomes for the baby are especially a risk if the benzodiazepine is taken during the late third trimester. Babies born shortly after benzodiazepine exposure have shown signs of:

  • Sedation
  • Slowed breathing
  • Withdrawal
  • Feeding problems

Benzodiazepines formerly were linked to malformations like cleft lip and palate, but the data supporting this is no longer clear. For this reason, neither the CDC nor benzodiazepine package labeling discusses cleft lip and palate.

How long after giving birth should I wait before taking medication?

Your doctor will weigh the benefits and risks of you taking medications after birth. How soon it is safe to take benzodiazepines after giving birth will depend on your medical history and if you are planning to breastfeed. Breastfeeding is not recommended if you are taking a benzodiazepine.

What is the safest benzo to take while pregnant?

Benzodiazepines have all been deemed to have similar risks in pregnancy.

What pregnancy category are benzodiazepines?

The FDA no longer labels drugs with pregnancy categories. Benzodiazepines used to be Category D based on old data about fetal malformations, but experts now think the relationship between benzodiazepines and birth defects is less clear.

When the Benefits of Benzodiazepines in Pregnancy Outweigh the Risks

Your doctor can help you determine when the benefits of continuing a benzodiazepine in pregnancy outweigh the risks. Having an untreated mental health disorder carries risks of its own in pregnancy, which include:

  • Poor adherence to prenatal care
  • Poor nutrition
  • Risk of alcohol abuse
  • Risk of tobacco use

If your doctor believes that keeping you off a benzodiazepine puts you and your baby at more health risk than continuing you on the drug, you may be instructed to continue it.

How To Treat Anxiety Symptoms Without Benzodiazepines During Pregnancy

If your doctor supports stopping your benzodiazepine use during pregnancy, it may be important to have a strategy with other ways to treat your anxiety. In some cases, your doctor may prescribe an alternative medication for you. The exact medication will depend on your medical history.

However, nonpharmacologic alternatives are also available. They can be done on their own or combined with medication to help treat anxiety while pregnant. These alternatives include:

  • Cognitive-behavioral therapy
  • Yoga
  • Massage
  • Acupuncture

Finding Help for Benzo Use While Pregnant

Help is here for soon-to-be moms who want to stop using benzos before they become pregnant. In many cases, you can work with your healthcare provider to gradually lower the benzodiazepine dose over time. This strategy of tapering off benzodiazepines will help you avoid severe withdrawal symptoms.

If you are unable to stop using benzodiazepines while you are pregnant, it is important to let your doctor know as soon as possible so that your baby can be appropriately monitored.

Our caring experts at The Recovery Village are here if you need help quitting benzodiazepine use. Don’t wait: call us today and put yourself and your baby on the path to a healthy future.

Melissa Carmona
Editor – Melissa Carmona
As the content manager at Advanced Recovery Systems, Melissa Carmona puts years of writing and editing experience to work helping people understand substance abuse, addiction and mental health disorders. Read more
Jessica Pyhtila
Medically Reviewed By – Dr. Jessica Pyhtila, PharmD
Dr. Jessica Pyhtila is a Clinical Pharmacy Specialist based in Baltimore, Maryland with practice sites in inpatient palliative care and outpatient primary care at the Department of Veteran Affairs. Read more
Sources

Massachusetts General Hospital Center for Women’s Mental Health. “Anxiety During Pregnancy: Options for Treatment.” April 30, 2015. Accessed October 11, 2021.

Tinker, Sarah C.; Reefhuis, Jennita; Bitsko, Rebecca H.; et al. “Use of benzodiazepine medications during pregnancy and potential risk for birth defects, National Birth Defects Prevention Study, 1997–2011.” Birth Defects Research, June 1, 2019. Accessed October 11, 2021.

Drugs.com. “Xanax.” September 1, 2021. Accessed October 11, 2021.

Centers for Disease Control and Prevention. “Pregnant Women Report Taking Medicines for Anxiety and Other Mental Health Conditions.” December 9, 2020. Accessed October 11, 2021.

U.S. Department of Health and Human Services. “FDA Pregnancy Categories.” August 16, 2021. Accessed October 11, 2021.

U.S. Food and Drug Administration. “Pregnant? Breastfeeding? Better Drug Information Is Coming.” December 17, 2014. Accessed October 11, 2021.

Armstrong, Carrie. “ACOG Guidelines on Psychiatric Medication Use During Pregnancy and Lactation.” American Family Physician, September 15, 2008. Accessed October 11, 2021.

Medical Disclaimer

The Recovery Village aims to improve the quality of life for people struggling with substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare providers.