Up to 15% of pregnant women have an anxiety disorder, and 1-4% of them are treated with benzodiazepines (like Valium®, Xanax® or Klonopin®) or z-drugs (like Ambien®). In addition, it’s not uncommon for women with anxiety to also be treated for depression, or for benzodiazepines to be used in combination with a prescription opioid for pain management. But what effects might benzodiazepines and z-drugs, in isolation or in combination with an antidepressant or a prescription opioid, have on longer-term developmental outcomes in a pregnant woman’s baby? Our new study examined this very question.

How did we do it? We accessed a large dataset from the Norwegian Mother and Child Cohort Study, which followed over 41,000 pregnant women from 1999 to 2008 and had child follow-up data from 6 months to 8 years of age. In the study were 4,195 women who before and/or during pregnancy had a depression/anxiety disorder, 5,260 with a sleeping disorder, and 26,631 with a pain-related disorder. We looked at whether the timing of benzodiazepine/z-drug exposure (mid-pregnancy vs. late pregnancy) had any effects on the child’s longer-term development; whether longer vs. shorter duration of use (multiple 4-week vs. 1-week intervals) had any effect; and how the use of benzodiazepines/z-drugs in isolation or in combination with an antidepressant or a prescription opioid affected the child’s development. The child outcomes we looked at were the development of both motor and communication skills as well as attention problems when the children were around 5 years of age.

What did we find? Our findings suggested no increased risk for attention problems or fine motor deficits after benzodiazepine/z-drug exposure at different time points in pregnancy. We also did not find any evidence suggesting there was a developmental risk based on how long the mom used these drugs, nor any increased risk if benzodiazepines/z-drugs were used in combination with either antidepressants or a prescription opioid. There was an increased risk of gross motor and communication deficits among children whose mothers had depressive/anxiety disorders and used benzodiazepines/z-drugs late in pregnancy (week 29 or later), but the deficits were below clinically relevant cutoff points and could be accounted for by the mom’s underlying psychiatric conditions and/or the higher doses she was taking.

So what’s the take-away? Our findings suggest no substantial detrimental risk to child fine motor skills and attention problems after prenatal exposure to benzodiazepines/z-drugs alone or in combination with opioids or antidepressants. While an increased risk of gross motor and communication deficits was found, the deficits were not clinically significant and could be explained by other factors. As with any medication, pregnant women or women planning a pregnancy should talk with their healthcare provider before starting or stopping any medications.

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