Benzodiazepines & Pregnancy: Are They Safe To Take?
Last Updated Dec 2, 2021
There is some controversy regarding the question of whether benzodiazepines are safe to take during pregnancy.
According to the CDC, current research suggests that there is a small increase in the risk of birth defects if benzodiazepines are used during pregnancy, but there is not enough evidence to claim that benzodiazepines are dangerous to use during pregnancy.
Benzodiazepines are classified as depressant drugs that result in sedation. They are primarily used to relieve anxiety, control muscle spasms, reduce seizures, and treat epilepsy.
Benzodiazepines are frequently prescribed to women of reproductive age as well as pregnant women. Generally, benzodiazepines are prescribed to this group to reduce anxiety and to manage preeclampsia or eclampsia, which can often occur during the latter portion of pregnancy.
If a pregnant person takes benzodiazepines, there is some risk involved. They have been shown to produce sedative effects in the baby, especially when these drugs are used close to the end of pregnancy.
Benzodiazepine Effects on the Developing Fetus
Possible negative effects that can occur when taking benzodiazepines during pregnancy include the following:
- Insufficient growth
- Facial clefts
- Heart issues
When it comes to the risk of malformation, this risk is at its greatest if the fetus happens to be exposed to these drugs between two and eight weeks after conception.
If these drugs are taken or administered at or near term, fetal dependence and eventual withdrawal symptoms can occur as a result.
What Is Neonatal Benzodiazepine Withdrawal?
Various studies have shown that the use of benzodiazepines, opioids, and other prescription drugs can increase the risk as well as augment the severity of neonatal drug withdrawal. When a baby develops a dependence during fetal development, the baby will end up going through neonatal benzodiazepine withdrawal when that drug use is discontinued.
Every 25 minutes an infant is diagnosed with symptoms of drug withdrawal in the United States alone.
Benzodiazepine use can also worsen the impact of neonatal abstinence syndrome, which is a more severe case of drug withdrawal that requires medical intervention. Often, babies who suffer from neonatal abstinence syndrome require prescription drugs like morphine for treatment.
Benzos & Breast Milk
All of the major classes of benzodiazepine compounds are assumed to be excreted into milk. Benzodiazepines are also believed to be readily diffused across the placenta to the developing fetus.
The amount of a drug excreted via breast milk is dependent on the characteristics of the drug used. Certain factors — such as drug half-life, plasma protein binding, degree of lipophilicity, molecular weight, and maternal blood concentrations — can affect drug concentration in breast milk.
Lipid solubility and molecular weight of the benzodiazepine in question remain the strongest determiners of drug exposure during pregnancy and during lactation.
Effects of Benzodiazepine Use on the Child
As stated above, benzodiazepine use can affect a developing fetus, and benzodiazepine use can continue to have an effect on the child when they are breastfeeding.
Potential risks and outcomes include drug dependency and withdrawal. Again, there are a variety of birth defects that can also occur when a fetus is exposed to benzodiazepines at any stage of development, particularly during the first trimester.
What Situations Would Outweigh the Risks of Taking Benzos While Pregnant?
Many medical professionals strongly discourage the use of benzodiazepines during pregnancy due to the risks posed to the developing fetus. Your doctor will likely not want to risk sedation and/or drug withdrawal in the baby.
Although neonatal outcomes vary depending on the drug used as well as certain physiological factors, it is best to reduce any risks that prescription medications pose to a developing fetus during pregnancy. If these drugs are being used for their sedative and anti-anxiety properties, it is often preferred to explore alternative solutions during pregnancy.
Psychiatric care is a popular option for treating anxiety and sleep disorders. If there is a history of substance misuse, addiction treatment is recommended to help individuals identify triggers that lead to substance abuse and learn to cope with them better.
If benzodiazepines are being used for anxiety, holistic treatment may be explored, such as yoga, meditation, and other mindfulness and relaxation techniques. Behavioral therapy can also help to change thought processes and resulting actions, helping individuals to cope with anxious thoughts in a healthier manner.
If benzodiazepines are being used for the treatment of muscle spasms or seizures, the importance of taking the drug may outweigh the potential risks. Your doctor will help you make the best decision for your situation.
Tapering Off Benzodiazepines
The best way to ensure there are no complications during pregnancy is to plan ahead. But of course, not all pregnancies happen as planned. Individuals who are attempting to have a child may want to consider tapering off certain prescription medications prior to conception. Talk to your doctor if you are planning to become pregnant about the best approach.
If you have been taking benzodiazepines and discover you are pregnant, talk to your doctor promptly. Do not attempt to suddenly stop taking benzodiazepines on your own, as this can lead to withdrawal symptoms, some of which can potentially be life-threatening. Generally, a tapered approach to withdrawal is recommended.
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Effects of Commonly Used Benzodiazepines on the Fetus, the Neonate, and the Nursing Infant. (January 2022). Psychiatric Services.
Risk of Neonatal Drug Withdrawal After Intrauterine Co-Exposure to Opioids and Psychotropic Medications: Cohort Study. (August 2017). BMJ.
Neonatal Abstinence Syndrome Worse With Benzodiazepine Exposure. (July 2019). PAINWeek.
Pregnancy and Neonatal Outcomes After Exposure to Alprazolam in Pregnancy. (April 2022). Frontiers in Pharmacology.
Associations of Maternal Use of Benzodiazepines or Benzodiazepine-like Hypnotics During Pregnancy With Immediate Pregnancy Outcomes in Norway. (June 2020). JAMA Network Open.
Benzodiazepines in Pregnancy. (March 2019). Clinical Obstetrics and Gynecology.
Prevalence of Exposure to Benzodiazepines Among Pregnant Women in Taiwan: A Nationwide Longitudinal Study. (July 2022). Journal of Sleep Research.
The Fetal Safety of Benzodiazepines: An Updated Meta-Analysis. (January 2011). Drugs in Pregnancy.
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