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Table 4. Benzodiazepine Tapering Considerations by
Pregnancy Trimester
1st trimester 2nd trimester 3rd trimester Postpartum
Potential Fetal
Effects of BZDs
Minimal
evidence of fetal
malformations
Increased risk of
preterm birth
Increased risk
of preterm
birth, low
birth weight,
cesarean
delivery,
ventilatory
support
Concern for
withdrawal
and potential
fetal effects
if high
doses are
used during
lactation
Potential Effects
of Pregnancy
on BZD
Pharmacokinetics
Increased volume
of distribution
and CYP2C19,
CYP3A4,
and CYP2C9
metabolism
(resulting in
decreased effect)
Decreased
CYP1A2 and
CYP2C19 activity
Increased
volume of
distribution
and CYP2C19,
CYP3A4,
and CYP2C9
metabolism
(resulting in
decreased
effect)
Decreased
CYP1A2 and
CYP2C19
activity
Increased
volume of
distribution
and CYP2C19,
CYP3A4,
and CYP2C9
metabolism
(resulting in
decreased
effect)
Decreased
CYP1A2 and
CYP2C19
activity
Reversal of
pregnancy
changes may
increase
effect
Causes of
Insomnia
Nausea, urinary
frequency, back
pain
Fetal
movements,
heartburn,
leg cramps,
shortness of
breath
Fetal
movements,
heartburn,
leg cramps,
shortness of
breath
Infant care,
pain
