Size of the Problem:
In a review of the current literature on the effects of prenatal BDZ by Dr Particia McElhatton, she states that between 30 and 40% of all pregnant women will be given a BDZ at some point during pregnancy. I believe that this figure is probably too high. However if the illicit use of BDZs by street drug users, (many of whom are of childbearing age), is taken into account the number of unborn babies currently exposed to BDZs may be much higher. We don't know.
Opiate and methadone users are also commonly prescribed BDZs. This has been noted by the Advisory Council on Misuse of Drugs in their report on Drug - related deaths this year.

Effects:
Babies exposed to BDZs before birth are at risk from several factors:
First, BDZs can damage babies due to the direct effects of the drug, causing both withdrawal and "floppy infant syndrome". The last happens when the baby is unable to metabolize the drug at birth.
Secondly, BDZs can interfere with the developing nervous system at all stages of pregnancy.
Thirdly,the possibility of BDZs causing major malformations, such as cleft palate remains an area contention. However a Current extract from a recent review states:

"Benzodiazepines can cause fetal dysmorphism (including microcephaly),

Weintraub Z; Bental Y; Olivan A; Rotschild A. -
Neonatal withdrawal syndrome and behavioral effects produced by maternal drug use. (review). Addiction Biology (2): 159-170, 1998. (101 refs.)


Neurodevelopment:
In rats, it has been found that an antagonist ("antidote") to BDZS - flumazenil, if given to pregnant BDZ exposed mothers successfully reverse many of the BDZ-induced changes seen in the offspring at puberty.
Animal studies show that BDZs interfere with neurodevelopment, at all stages and human studies in Sweden conclude that:

" Infants born to mothers exposed to the long term, regular use of BDZs in therapeutic doses run the risk of an overall deviation in neurodevelopment during their first 18 months".
The changes seen can result in later disorders such as behavioural problems, dyslexia, dyspraxia, A.D.D. etc. Many of the problems often do not come to light until puberty and the most recent research in this area conclusively supports this.
Anecdotal reports reflect the scientific findings both from animal and human research. It is of interest that a number of families have reported a marked difference between BDZ exposed and unexposed siblings - the unexposed children showing none of the alleged effects.

Neonatal withdrawal syndrome:
withdrawal from BDZs can appear up to a few weeks after birth and can be severe and prolonged, lasting up to three months.This may need treatment in hospital.
Paediatrician DrJames Robertson ranks BDZs as more dangerous to the newborn babies than opiates.

Metabolic Failure:
Some newborn babies are not mature enough to metabolize BDZs resulting in them suffering the effects of the active BDZ and its metabolites in their systems. Apnoea, low body temperature, lack of muscle tone, inability to feed and drowsiness are the result. Due to the long half lives of many BDZs and other factors not fully understood, as in adults, it can take a long time for BDZs to leave the system. In comparison with other drugs, such as opiates BDZs can remain in the baby's system for weeks or months. Babies affected in this way need hospital treatment.

Danger of Sudden Infant Death:
it is known that the GABA system in the brain is involved in the regulation of breathing and that BDZs affect the GABA system. Apnoea, and other respiratory problems are caused by BDZs in both adults and babies.
In their report on drug-related deaths, the Adivisory Council on the Misuse of Drugs states that BDZS are responsible for an increase in drug-related deaths due to respiratory failure. They also express concern that the mixture of BDZs and opiates is a lethal cocktail, both acting in different ways on the respiratory system.
If this mixture is lethal to adults - what effect could this have on newborn babies?
In a letter to the Lancet in 1977, paediatrician Dr Nigel Speight, wrote of a baby suffering the effects of prenatal BDZ exposure, that the baby might have died had he not been admitted to a special care nursery.
Incredibly, there has been very little research into the relationship between BDZs and Sudden Infant Death, but it seems likely that there will be a link.

Poor parenting:
Last, but not least, children whose parents are long term BDZ users are likely to suffer the consequences of having a parent who is generally disabled due to the drugs.
In fact, some studies show that children whose mothers take BDZs are more likely to misuse drugs themselves.
An example of the sort of difficulties these children can face: is a parent who becomes a prisoner in their own home. An increasing difficulty in leaving home, or tolerating changed surroundings is a common problem with long term BDZ use, regardless of whether the person suffered this before. This is probably due to BDZ-induced cognitive impairment. This has profound consequences for a child. I have here an extract from a letter written by someone whose mother has been prescribed BDZs for for 39 years. The original reason for prescription was because she had a violent husband:

"I remember coming home from school and getting sent straight to the shops to get the shopping in. It was a case of if we didn't go to the shops, we didn't get any tea.

We were often kept off school so we could collect prescriptions (for her benzos) from the doctors.

I'm still doing my mother's shopping, only this time, my brothers and sisters and myself aren't relying on it for our own meals.

I looked after my grandparents for five years until they passed away. I always felt it was my mother's job to see to her parents.

My mother is the same now as when we were young, only now I'm old enough to walk away."

Conclusion:
A drug which is considered an old problem, is in fact a new plague, with devastating consequences for the next generation.
I have not been able to find any reference to the dangers to the unborn child in the criteria for the classification of drugs of misuse, but in the light of current evidence that to leave benzodiazepines as class 'C' is indefensible.

S. Bibby,
2nd Nov. 2000.