BMJ
Sedative use in pregnancy not tied to kids’ psychiatric risk, large study finds
Clinical takeaway: Prenatal exposure to benzodiazepines or Z-hypnotics does not appear to increase the risk of psychiatric disorders in children after accounting for shared familial factors, though cautious use—especially later in pregnancy or with prolonged exposure—remains prudent.
Benzodiazepines and Z-hypnotics are commonly used to treat anxiety and insomnia during pregnancy, but concerns about long-term neuropsychiatric effects in children often complicate treatment decisions.
In a nationwide South Korean cohort of 3.8 million births (2010–2022), 94,482 children (2.5%) were exposed in utero to benzodiazepines or Z-hypnotics and followed for a median of about 7 to 8 years.
Crude analyses suggested higher psychiatric risk among exposed children, with a hazard ratio (HR) of 1.48 and a cumulative incidence of 19.2% vs. 13.8% in unexposed peers by age 13. However, adjustment for confounders reduced the association (weighted HR, 1.15), and comparisons with “past users” showed further attenuation (HR, 1.12).
Critically, sibling-controlled analyses—designed to address shared genetic and environmental factors—found no increased risk (HR, 0.99; 95% confidence interval, 0.94–1.04). Individual psychiatric outcomes, including ADHD, autism spectrum disorder, mood, and anxiety disorders, also showed no meaningful elevation after these adjustments.
Subgroup analyses hinted at modest but non-significant increases with exposure later in pregnancy or for longer durations, particularly with Z-hypnotics (e.g., ≥30 days: HR, 1.31, 95% CI, 0.96–1.78 in sibling analysis).
“Our findings provide reassurance about the neuropsychiatric safety” of these medications in pregnancy, the authors wrote, though they noted that “the potential for a slightly increased risk in specific contexts… could not be ruled out.”
Overall, the results suggest that previously observed associations may largely reflect underlying maternal conditions or familial risk rather than drug exposure itself, helping inform more balanced risk–benefit discussions in clinical care.
Source: Cho Y, et al. (2026, April 29). BMJ. Benzodiazepine or Z-hypnotic use during pregnancy and risk of psychiatric disorders in children: population based cohort study