Benzodiazepines and Pregnancy: What to Know About Risks and Safer Care

If you are pregnant and taking benzodiazepines, or know someone who is, it’s important to learn what current evidence says about benzodiazepines during pregnancy and breastfeeding, including medication risks, the risks of untreated anxiety or seizures and why one-size-fits-all answers are misleading.

You will also learn about what safer, coordinated care looks like if you are pregnant, postpartum or planning a pregnancy and currently taking Xanax, Ativan, Klonopin, Valium or another benzodiazepine.

Are Benzodiazepines Safe During Pregnancy?

This is the question most people ask first, and the honest answer is: it depends. Benzodiazepines are not risk-free during pregnancy. However, saying they are completely unsafe ignores situations where untreated panic, severe anxiety, insomnia or seizures can also put the pregnant patient and fetus at risk.^1,2

That is why current guidance emphasizes individualized risk-benefit decisions rather than one-size-fits-all rules. According to guidance from the American College of Obstetricians and Gynecologists (ACOG), psychiatric medications in pregnancy should be prescribed only after carefully weighing the risks of medication exposure against the risks of untreated illness.³

Above all, the focus should be on what is safest for the specific patient.³ For some people, continuing a benzodiazepine for anxiety may be the most beneficial option. For others, tapering, switching medications, or using non-medication supports may be the safest option. These decisions are ideally made before conception, when there is more time to review the diagnosis, dose, timing and alternatives.³

If you are currently taking a benzodiazepine and are pregnant or trying to conceive, contact your prescriber and OB. Do not stop suddenly on your own, especially if the medication is being used regularly or for seizure control, because abrupt discontinuation can also carry significant risks.⁴

The FDA’s Pregnancy and Lactation Labeling Rule (PLLR)

If you’ve read older articles about benzodiazepines in pregnancy, you’ve probably seen the outdated FDA letter categories: A, B, C, D, and X. Those categories were introduced in 1979, but over time, they were criticized for being too simplistic. That is why the FDA replaced the letter system with the Pregnancy and Lactation Labeling Rule (PLLR), which took effect on June 30, 2015. Newer prescription drug labels no longer use letter categories and instead provide detailed narrative sections, while older labels are updated on a phased timeline.^4,5

Under the FDA PLLR, pregnancy-related prescribing information appears in three sections: Pregnancy, Lactation and Females and Males of Reproductive Potential. Instead of assigning a letter grade, these sections summarize the available risk data in plain language and include clinical considerations such as disease-associated maternal and fetal risk, dose adjustments, adverse reactions and relevant counseling points.^4,5

Many benzodiazepines were previously listed under Category D, meaning there was positive evidence of fetal risk but that potential benefits could still justify its use, in some cases. Diazepam and similar medications are now described using PLLR narrative labeling rather than a single category letter.^4,5

If a webpage says a benzodiazepine is “Category D” or “Category X” without making clear that it is using the old FDA framework, it is relying on outdated labeling language. It’s important to look for current labels that are more detailed, more nuanced and more useful for real risk-benefit decision-making.

Specific Risks of Benzodiazepine Use During Pregnancy

The risks of benzodiazepine use during pregnancy appear to increase in certain situations, especially depending on the timing of exposure, dose and which benzodiazepine is used. Those risks must still be weighed against the risks of untreated anxiety, panic, insomnia or seizure disorders.

First-Trimester Risks: Oral Clefts

Pregnant individuals who use benzodiazepines during the first trimester are said to have a 0.01 percent increased chance of oral clefts in their infants. This equates to approximately 7 in 10,000 infants, when compared to individuals who have not used benzodiazepines, which has an occurrence rate of approximately 6 in 10,000 infants, according to ACOG Practice Bulletin No. 92. For this reason, the use of benzodiazepines, especially diazepam in the first trimester, should be weighed against the risk of untreated illness.

Third-Trimester Risks: Floppy Infant Syndrome

Use of benzodiazepines shortly before delivery has been associated with floppy infant syndrome, which can include symptoms such as hypothermia, lethargy, poor respiratory effort, and feeding difficulties at birth. These symptoms usually improve as the infant clears the medication from their system.^7,8

Neonatal Abstinence Syndrome (NAS)

Benzodiazepine exposure during pregnancy can lead to neonatal withdrawal symptoms after birth. Reported symptoms include restlessness, hypertonia, hyperreflexia, tremor, apnea, vomiting, and diarrhea. These symptoms can last days to months, especially after exposure to long-acting agents. Neonatal abstinence syndrome benzo is often less severe than opioid NAS, but it still warrants close neonatal monitoring.^9,10

Benzodiazepine Withdrawal: Symptoms, Timeline and What to Expect

October 1, 2026 • Lisa Conaster

Benzodiazepine withdrawal occurs when a physically dependent person reduces or stops using the medication. Symptoms range from mild to severe and affect both your physical and psychological health. Because benzodiazepine withdrawal can be extremely uncomfortable and unpredictable It is recommended to seek medical care when going through benzo withdrawal. This guide offers details on the […]

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Long-Term Neurodevelopment

The evidence on long-term neurodevelopment is mixed and difficult to interpret because maternal anxiety and other confounders are hard to fully separate from the effects of the medication. A large Norwegian cohort study found that early behavioral signals were substantially attenuated after adjustment for residual confounding. Another study reported no associations with internalizing symptoms in early childhood. The truth is that the data is imperfect, the signals are small and strong causal conclusions are still hard to make.^11,12

The Other Side: Risks of Untreated Anxiety, Panic and Seizures During Pregnancy

Any discussion of benzodiazepines in pregnancy is incomplete if it only lists medication risks. This is especially true because untreated severe anxiety, panic disorder and seizure disorders also carry meaningful risks for both the pregnant person and the baby.³

Untreated severe maternal anxiety or dual diagnoses have been associated with adverse pregnancy outcomes, including preterm birth and low birth weight, and they can also make it harder to maintain sleep, nutrition and consistent prenatal care. Pregnancy is already a major life transition, and for some people, it is also the first time clinically significant anxiety symptoms have appeared or worsened.^13,14

Panic disorder should not be minimized either. During pregnancy, it can become disabling, and uncontrolled symptoms may continue well into the postpartum period or contribute to more severe anxiety after delivery. That matters clinically because the postpartum period is already a time of elevated psychiatric vulnerability.^15,16

For people with seizure disorders, abrupt medication changes can be especially dangerous. Uncontrolled seizures during pregnancy can directly harm both the pregnant person and the fetus through trauma, hypoxia, and other complications. This is why seizure treatment decisions generally require close coordination with obstetric and neurology clinicians.¹⁷

An important risk to note is that when people stop a medication suddenly without an alternative plan, some may turn to alcohol, cannabis or unprescribed sedatives to cope. That is one reason to avoid taking blanket advice to discontinue benzodiazepines during pregnancy and instead work with a doctor who can evaluate your specific situation.³

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Drug-Specific Considerations

Not one of the common benzodiazepines is universally “safe” or “unsafe.” Doctors must consider how the drug’s properties, the available evidence and the reason it is being used fit into an individualized pregnancy treatment plan.

Xanax (Alprazolam) During Pregnancy

Can you take Xanax while pregnant? It depends. Alprazolam crosses the placenta, so fetal exposure occurs when it is used during pregnancy. The safety data remain limited, and much of the older literature comes from case reports or observational studies rather than large, randomized datasets.

A 2022 Korean prospective cohort study comparing 96 alprazolam-exposed pregnancies with 629 unexposed pregnancies did not find a statistically significant increase in major malformations, but the small sample size made it hard to rule out a minor risk.¹⁸

The practical takeaway is that Xanax use during pregnancy should be approached with the same risk-benefit as other psychiatric medications in pregnancy. Use coordinated decision-making with the doctor.³

Ativan (Lorazepam) During Pregnancy

Lorazepam is often viewed as one of the relatively more manageable benzodiazepines in pregnancy because it is metabolized by glucuronidation and does not have active metabolites. That pharmacology can matter clinically, especially when Ativan is medically necessary, and the goal is to limit prolonged fetal or neonatal exposure. Even so, lorazepam crosses the placenta during pregnancy, and like other benzodiazepines, it can contribute to neonatal sedation, respiratory depression or withdrawal if used near delivery.¹⁹

That is why Ativan during pregnancy is sometimes used when there is a clear indication, but still with close obstetric and psychiatric oversight, rather than as a blanket “safe” option.³

Klonopin (Clonazepam) During Pregnancy

Clonazepam has a relatively long half-life, which means fetal exposure lasts longer after each maternal dose than with shorter-acting benzodiazepines. That matters most near delivery, when longer drug persistence may increase the duration of neonatal effects or Klonopin withdrawal symptoms.²¹

Clonazepam is also commonly used for panic disorder and seizure control, and both of those indications can make continuation during pregnancy more clinically necessary.²¹ The available safety data is limited and not definitive, so the decision to use Klonopin during pregnancy usually comes down to indication severity, dose, timing and whether a safer or better-studied alternative is realistic.

Valium (Diazepam) During Pregnancy

Diazepam has been linked to first-trimester oral cleft risk, low birth weight and neurodevelopmental issues. However, evidence of absolute risk remains very limited. Diazepam also has a long half-life and active metabolites, which means fetal exposure can persist longer than maternal blood levels alone might suggest.⁶

Even with those concerns, the benefits of Valium use during pregnancy may outweigh the risks, like in situations such as status epilepticus or severe acute anxiety crises. In these circumstances, the risk of not treating the condition is greater than the medication risk.

This is the central theme across all benzodiazepines in pregnancy. The right choice depends on the drug, the dose, the timing and the reason it is needed.^3,6

Tapering Benzodiazepines During Pregnancy

If someone is pregnant and currently taking a benzodiazepine, stopping cold turkey is not the safe default. Abrupt discontinuation can trigger withdrawal seizures, severe rebound anxiety, autonomic instability and acute distress that may also affect the fetus. In pregnancy, that makes benzodiazepine tapering a textbook supervised-taper situation, not a do-it-yourself medication change.^22,23

The clinical challenge is balancing two real risks at the same time: ongoing fetal exposure if the medication is continued, versus maternal withdrawal, panic, seizures and self-medication if it is reduced too quickly. This is why any decision to continue, taper or switch medications should be made under medical supervision, with the entire treatment team.^3,22

In practice, benzodiazepine tapering during pregnancy is often slower and more conservative than tapering in a non-pregnant patient. The goal is not simply to get off the medication as fast as possible. It is to reduce exposure while avoiding withdrawal complications, destabilization and substitution with alcohol, cannabis or unprescribed sedatives. In some cases, the safest plan may extend into the postpartum period rather than forcing a rapid taper during pregnancy.²³

For patients taking higher doses, using multiple sedating substances or with a history of withdrawal seizures, severe dependence, or unstable psychiatric symptoms, medical detox or higher-level monitoring may be recommended.

The safest takeaway is simple: do not stop a benzodiazepine on your own during pregnancy. The right taper should be designed and monitored by the clinicians managing both the pregnancy and postpartum addiction treatment and any other underlying conditions.

How to Taper Off Benzodiazepines Safely

October 1, 2026 • Amanda Berkey

To taper safely from benzodiazepines requires medical supervision and careful planning. Benzodiazepines work by affecting the nervous system, and stopping them abruptly can trigger serious withdrawal symptoms, including seizures. This guide explains how tapering works, what to expect during the process, and how to find a provider experienced in benzodiazepine withdrawal. Why Tapering Is Safer […]

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Benzodiazepines and Breastfeeding

If an individual is taking benzos while pregnant, it’s important to know that they do pass into breast milk. That does not automatically mean breastfeeding has to stop. Focus should be on which benzodiazepine, at what dose and the infant.

For many breastfeeding patients with a healthy infant, most current guidance considers occasional short-term use of a shorter-acting benzodiazepine compatible with breastfeeding when the medication is medically necessary.^24,25

Lorazepam and oxazepam are generally preferred during benzodiazepine breastfeeding because they are shorter-acting and less likely to accumulate in the infant. For this reason, they are the preferred options for breastfeeding patients when clinically appropriate.^24,25

The main concerns are infant sedation, poor feeding and inadequate weight gain. These risks matter more in preterm infants, babies with impaired drug metabolism, or infants who are already struggling with sleepiness or feeding. In these situations, even medications that are usually manageable in breastfeeding may require extra caution, closer monitoring or a different plan altogether.^24,26

If you are breastfeeding and taking a benzodiazepine, the safest next step is to review the exact medication with your prescriber and your child’s pediatrician rather than assuming all benzodiazepines carry the same level of risk.³

Coordinated Care: OB-GYN and Mental Health Together

Benzodiazepine decisions during pregnancy are best made jointly, not by one clinician alone. An OB-GYN may not specialize in benzodiazepine pharmacology, withdrawal risk, dual diagnosis anxiety care, or a supervised tapering strategy. Conversely, a mental health, addiction medicine, or neurology clinician may not be the expert in fetal risk assessment, delivery planning or neonatal monitoring.

Coordinated care tends to produce the safest outcomes. The real question is not just whether to continue or stop a medication, but how to balance maternal stability, fetal safety, symptom control and neonatal planning at the same time.³

For patients with dependence, high-dose use, co-occurring substance use, severe anxiety, panic disorder or seizure disorders, specialty perinatal rehab programs for pregnant and postpartum mothers are often the highest standard of care. These programs bring obstetric and behavioral health expertise together for pregnant and postpartum patients, which is the kind of integrated approach benzodiazepine treatment in pregnancy requires.^23,27,28

Rehab for Pregnant and Postpartum Mothers

October 1, 2026 • Amanda Berkey

Drug rehab for pregnant and postpartum mothers requires specialized, comprehensive care that prioritizes the health and safety of both parent and baby. These programs integrate addiction treatment with prenatal, postpartum and mental health support, helping women access medically supervised detox, evidence-based therapies and practical services that promote stability and long-term recovery throughout pregnancy and early parenthood. Key Facts […]

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Frequently Asked Questions

Find Treatment During and After Pregnancy

If you’re pregnant, postpartum or planning pregnancy while taking a benzodiazepine, don’t stop or change it on your own. The safest step is to get prompt, medically supervised care from an OB-GYN, psychiatrist, addiction specialist or perinatal mental health program to protect both you and your baby.

Early support during pregnancy and after delivery can improve safety as symptoms, relapse risk and medication needs change. If you need help finding the right provider, our team can connect you with appropriate care.

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