The use of BDZs during pregnancy was considered for a long time at risk of inducing structural birth defects, particularly cleft lip and cleft palate. The aim of this chapter is to briefly summarize the results of the best recent evidences concerning the risks of major malformations (MMs) and perinatal complications (PCs) in newborns of women exposed to benzodiazepines (BDZs) and Z-drugs in early and late pregnancy. There is substantial agreement in the current literature that BDZs exposure during the first trimester of pregnancy is not associated with an increasing risk of MMs. However, during the second and third trimester of pregnancy, BZDs exposure may be associated with few neonatal adverse effects, particularly a withdrawal or abstinence syndrome. No increase in the risk of neurodevelopment and/or cognitive disorders in infants exposed during pregnancy has been reported in most of the studies focusing on this issue. As well, even the data concerning the Z-drugs have not reported an increased risk of MMs and neonatal adverse outcomes in infants exposed in utero to such drugs. General principles of prescribing and clinical recommendations concerning the management of BDZs and Z-drugs during gestation are provided, according to the data coming from the international guidelines and the opinion of clinicians who are experts in this field.