by The consumption of anxiolytics (benzodiazepines) to treat anxiety and/or insomnia during pregnancy is associated with an increased risk of miscarriage. This is the conclusion of a study, published in the journal ‘JAMA Psychiatry’, which has analyzed more than three million pregnancies with more than 130,000 spontaneous abortions.
This case-control study, conducted by Taiwan University, revealed an increased risk of miscarriage associated with benzodiazepine use during pregnancy after accounting for medifiable confounders, and the results were unlikely to be due to unmeasured confounding factors.
These findings underscore the need for healthcare professionals to meticulously balance the risk-benefit ratio when considering the use of benzodiazepines to treat psychiatric and sleep disorders during pregnancy.
Current evidence-based recommendations suggest that during pregnancy, when choosing treatment for anxiety, consideration should be given to whether the potential benefits to the mother outweigh the potential risks to the fetus.
“Benzodiazepine use is defined very broadly, and narrower definitions lead to attenuated associations. Without a plausible mechanism, and with pharmacological assumptions about short-acting versus long-acting being untenable, it seems to me that this study should not change current practice. Of course, we must always be cautious during pregnancy with the use of any medication. However, there is no doubt that anxiety and severe insomnia also have detrimental effects on the mother and fetus,” he points out. SMC Christiaan Vinkers, psychiatrist and professor of Stress and Resilience at the University of Amsterdam Medical Center.
For his part, Simon Wessely, Regius Chair of Psychiatry at King’s College London, explains to SMC that this trial is defined as a ‘case control study’. “It is well carried out with a large number of cases, and I have no doubt that they found an association. But the big question is, Is this cause and effect? And the problem is that we can’t say it. There may be many reasons why someone prescribed benzodiazepines may also have a higher risk of miscarriage. They did their best to control for these factors, and the association persisted, but it’s always a problem in these types of studies. The main lesson is that, for many reasons, we must continue all efforts to reduce benzodiazepine prescriptions anyway, especially for longer periods.”
