In pregnancy, Ativan (lorazepam) exposure is associated with which neonatal outcome?

• A. Floppy baby and cleft palate
• B. Neonatal withdrawal syndrome
• C. Macrosomia
• D. Respiratory distress syndrome

Answer: (A)

Exposure to lorazepam during pregnancy can cross the placenta and depress the fetal CNS, leading to a floppy infant after birth. This newborn lethargy and hypotonia, often with poor feeding and potential respiratory compromise, is classically described as floppy baby syndrome. Some reports have also noted craniofacial anomalies like cleft palate with benzodiazepine exposure in early pregnancy, though the data aren’t definitive. The other options don’t fit as closely: neonatal withdrawal is typically linked to substances with stronger dependence potential, macrosomia relates to maternal diabetes, and respiratory distress syndrome is more about prematurity and lung maturity. Thus, the combination of floppy infant presentation with possible cleft palate best represents the neonatal outcome associated with lorazepam exposure.