Benzodiazepine use during pregnancy

Benzodiazepine use during pregnancy should be guided by the considerations outlined in Principles of psychotropic use during pregnancy.

Although data are limited, benzodiazepines are generally considered safe in pregnancy except in the third trimester, when they should be used with caution, under expert advice. Benzodiazepine use in the third trimester, especially those with a long half-life (eg diazepam, clonazepam) can cause poor neonatal adaptation, neonatal drowsiness, respiratory depression, poor temperature regulation, poor feeding and hypotonicity (‘floppy infant syndrome’). If a benzodiazepine must be used, if possible, use one with a shorter half-life (eg temazepam, lorazepam).

Although benzodiazepines have been associated with an increased risk of miscarriage, preterm birth and small-for-gestational-age infants, other confounders (eg severe mental health disorders, problem drug use) may have contributed to this risk. Earlier associations with fetal cleft lip or palate are not substantiated by prospective studies.

If the patient has been taking a benzodiazepine long term to treat insomnia, see here for advice on stopping the drug.

If the patient has been taking a benzodiazepine long term to treat an anxiety disorder and the decision is made to stop the drug, see here.