As noted in the package insert for clonazepam, an increased risk of congenital malformations associated with the use of benzodiazepine drugs has been suggested in several studies.

In addition, there have been reports of neonatal flaccidity, respiratory and feeding difficulties, and hypothermia in children born to mothers who had received benzodiazepines late in pregnancy. Such children may also be at risk for withdrawal symptoms.

The risk of defects is higher for women who take several medicines, and for women with a family history of birth defects.

Women who are capable of becoming pregnant should be advised to take 400 mcg (0.4 mg) of folic acid (folate) daily to help prevent neural tube defects. Women at high risk, such as those with a history of a neural tube defect in a previous pregnancy, should take 4000 mcg (4 mg) daily, beginning before they become pregnant.

During the last month of pregnancy, the woman should take 10 mg per day of vitamin K to prevent a bleeding disorder that affects some babies born to mothers who are taking anticonvulsants.

No studies have been performed to demonstrate the effect of specific AEDs during labor and delivery. Possible causes of seizures include:

• failure or inability to take medication
• sleep deprivation
• hyperventilation
• stress
• pain

Reviewed by Steven C. Schachter M.D., April 2005