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Can You Safely Use Benzodiazepines During Pregnancy?

Benzodiazepines are a class of drugs prescribed to treat general anxiety, anxiety associated with depression, insomnia, and, in rare cases, seizure disorders like epilepsy. The most famous benzodiazepine drugs include Valium, Xanax, Klonopin, Librium, and Ativan. Rohypnol is also an infamous, very potent benzodiazepine drug that is only prescribed to manage symptoms of certain sleep disorders in the United States, like narcolepsy.

This group of drugs collectively are known as central nervous system (CNS) depressants or sedatives. They bind to receptors in the brain that use a neurotransmitter called gamma-Aminobutyric acid (GABA), which is involved in slowing down communication between neurons. If your brain does not produce enough GABA on its own, you may have panic attacks, chronic anxiety, or, at worst, electrical surges leading to seizures. When benzodiazepines bind to these receptors, there is more of the GABA neurotransmitter available to manage these signals, which can lead to a sense of calm and relaxation.

Issues With Benzodiazepines

It is rare for benzodiazepine drugs to be prescribed for consistent use. Most, like short-acting Xanax and Klonopin, are prescribed for as-needed use, in moments of panic before or during a stressful situation. When benzodiazepines are prescribed for insomnia or a longer-lasting issue, they are not prescribed for more than two weeks because the body quickly becomes dependent on them and also tolerant of them. As a result, it becomes easy to develop compulsive behaviors to fill cravings or manage rebound anxiety.
Many people struggle with benzodiazepine abuse, but even when the medication is taken as directed, there are some situations in which it is not safe. For example, it is important to avoid alcohol while you take this medication because alcohol also acts on the GABA receptors, and this can lead to poisoning and hospitalization.

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For women who are pregnant or want to become pregnant, several foods, beverages, and medications become risky. Benzodiazepines can be very useful for those who struggle with anxiety or insomnia, but is it safe to take this medication while pregnant? If you are pregnant and struggle with benzodiazepine abuse, what can you do to get sober and healthy?

Are Benzodiazepines Safe to Take as Prescribed During Pregnancy?

One of the listed potential side effects of taking benzodiazepines during pregnancy is birth defects in the child. Because many benzodiazepines are prescribed for as-needed treatment, taking these medications as prescribed can be safe during pregnancy.
The average risk of birth defects during pregnancy in women who avoid harmful substances and other risk factors is 3 percent to 5 percent. This is called the background risk. A few early medical studies reported that there was a potential link between birth defects like a cleft palate when the mother took benzodiazepines, but follow-up studies have not corroborated this risk. Other studies had suggested an association between low birth rate or preterm deliveries when benzodiazepines were taken, but these have also not been verified by follow-ups.
A study spanning 1990 to 2010 in the United Kingdom followed women who took benzodiazepines in their first trimester and calculated the risks of birth defects called major malformations.

The prevalence was:

  • 2.9 percent in 379 children exposed to temazepam (Restoril).
  • 2.7 percent in 1,159 children exposed to diazepam (Valium).

The average rate of major malformations in the control group was 2.7 percent, so there was no significant difference between first-trimester exposure to benzodiazepines and no exposure. For women who need help managing panic attacks or insomnia, this means their doctors can safely prescribe these medicines when needed.
If benzodiazepines are taken regularly in the third trimester, however, this may lead to the infant experiencing withdrawal symptoms. In adults, benzodiazepines rapidly lead to physical dependence and tolerance, and it is possible that this may happen in utero, too. Withdrawal symptoms associated with benzodiazepines are uncomfortable and potentially life-threatening.

In infants, they may include the following symptoms:

  • Trouble breathing
  • Muscle weakness
  • Crying
  • Irritability
  • Physical discomfort
  • Sleep disturbances
  • Jitteriness and shaking
  • Tremors
  • Seizures

It is important to tell your pediatrician if you have taken benzodiazepines close to delivery, either as prescribed or for nonmedical reasons. The pediatrician can then watch for signs of withdrawal in your child so that the riskier symptoms can be treated. It will take up to two weeks to clear your child’s body, but benzodiazepines have not been associated with any long-term developmental difficulties.
A 2017 study found that there are a few increased risks from taking benzodiazepines or antidepressants during pregnancy. There was an increase in C-section births, and the babies more often needed oxygen support or other respiratory support after birth. Duration of the pregnancy was shortened by an average of 3.6 days.
If you have an anxiety disorder or develop anxiety during pregnancy, ask your doctor about the risks if you receive a prescription for benzodiazepines. The benefits of taking these medications as directed while pregnant can outweigh the risks. Suffering from frequent panic attacks or chronic anxiety increases the risk of miscarriage, preterm delivery, and delivery complications. However, these risks are also very low, so the choice of benzodiazepine treatment during pregnancy is very individual.

Benzodiazepine Abuse Poses a Risk to Mother and Child

Abusing any drug is risky, whether you are pregnant or not. Substance abuse during pregnancy increases risks to the developing fetus. Although benzodiazepines are associated with fewer negative outcomes, they may still cause harm if a large amount of the substance is in the body and passes through the placenta. The child is more likely to experience withdrawal symptoms when they are born, which increases the risk of serious health outcomes from breathing problems and seizures.
In 2008, there were about 75 million benzodiazepine prescriptions written in the United States, with 4 percent to 5 percent of the population taking these medications. About 2 percent of those with benzodiazepine prescriptions began abusing these drugs at increasing volumes, leading to acute and chronic health risks. About 2 percent to 18 percent of Americans report intentional misuse of benzodiazepine drugs, sedatives, or tranquilizers in their lifetime. In 2010, there were an estimated 186,000 people who began abusing benzodiazepines.
While most people who struggle with abuse or addiction to benzodiazepines take these drugs in conjunction with other substances — most often opioids, alcohol, or cocaine — they can also be abused alone. Trying to quit without help, or going cold turkey, is dangerous with benzodiazepines. Many withdrawal symptoms are like the conditions that benzodiazepines were designed to treat, including panic attacks, insomnia, and seizures.

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Withdrawal management in a medically supervised detox program may involve replacing the benzodiazepine of abuse with diazepam (Valium) because it is longer-lasting so that it can be used for tapering. However, this may not be appropriate, and a detox physician may choose to treat each symptom with other medications, like over-the-counter painkillers, as needed.
Working with an evidence-based detox and rehabilitation program is crucial since some withdrawal symptoms can be deadly. This is even more important if you are pregnant. A doctor can then monitor your health, along with the health of your child.

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