Women who use benzodiazepines during pregnancy may be more likely to experience miscarriage, according to a report in JAMA Psychiatry.
This finding underscores “the necessity for health care professionals to meticulously balance the risk-benefit ratio when considering the use of benzodiazepines to treat psychiatric and sleep disorders during pregnancy,” wrote lead author Fei-Yuan Hsiao, Ph.D., M.S., of the National Taiwan University College of Medicine and colleagues.
The population-based study in Taiwan used two national data sources to investigate the association between benzodiazepine use during pregnancy and the risk of miscarriage: the National Health Insurance database and the National Birth Certificate Application database. A total of 134, 864 pregnancies resulting in miscarriage between 2004 and 2018 were matched to an equal number of pregnancies carried to term, adjusted for demographic characteristics and pre-pregnancy comorbidities. Miscarriage was defined as any pregnancy loss occurring between the first prenatal care visit (usually 8 weeks) and the 19th completed week of pregnancy. Included in the analysis were 13 long-acting and 12 short-acting benzodiazepines.
For each pregnancy, benzodiazepine exposure occurring 1 to 28 days before miscarriage was considered the risk period. To account for potential variables like genetics and family environment, the women’s benzodiazepine use and other medical and lifestyle data during the risk period were compared with those from two reference periods: 31 to 58 days and 181 to 208 days before the last menstrual period.
Of the pregnancies resulting in miscarriage, 1,502 had been exposed to benzodiazepines during the risk period only, while among pregnancies carried to term, 753 had been exposed during the risk period only. After factoring in differences between the groups as well as differences during the reference periods, the researchers calculated that exposure to benzodiazepines was associated with a 69% higher risk of miscarriage.
In addition, each benzodiazepine in the study was associated with an increased risk of miscarriage, ranging from 39% for alprazolam to 152% for fludiazepam. Additionally, a dose-response association was observed between benzodiazepine exposure and miscarriage, with the risk increasing from 61% for low-dose exposure to 86% for high-dose exposure.
“These findings suggest that caution is warranted when using benzodiazepines during early pregnancy,” the authors wrote. “Prescribing benzodiazepines should only be considered following a comprehensive evaluation of the potential benefits and risks for both the mother and the child.”
For related information, see the Psychiatric News article “Perinatal Treatment Requires Careful Risks, Benefit Consideration.”
(Image: Getty Images/iStock/damircudic)
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