Benzodiazepines Linked To Increased Risk Of Miscarriage

When managing anxiety or sleep disorders, especially during pregnancy, there’s a growing interest in exploring safer alternatives to benzodiazepine medications.

Dr. Rachel Zhuk, assistant clinical professor at Mount Sinai Health System in New York City, recommends considering possibly safer treatments like psychotherapy and antidepressants like SSRIs for expectant mothers.

This recommendation comes after a recent study of over three million pregnancies and almost two million women in which Dr. Zhuk was not involved, found an increased risk of miscarriage associated with taking benzodiazepine medications when pregnant.

This research highlights the importance of being well-informed about the types and doses of medications, especially when considering the health of pregnant women. 

Dr. Fei-Yuan Sharon Hsiao, co-author of the study and a leading figure in clinical pharmacy, emphasizes the importance of assessing the risks and benefits when considering benzodiazepine prescriptions for pregnant women. This balanced approach is essential to protect the mother and the developing fetus.

The study, “Benzodiazepine Use During Pregnancy and Risk of Miscarriage,” assessed the safety of various benzodiazepines and the risk of miscarriage. The results showed the use of lorazepam was linked to a 42% increased risk, while alprazolam showed a 39% increase. Diazepam’s associated risk was higher at 69%, and oxazolam at 54%. Fludiazepam, prescribed in Taiwan and not FDA-approved, was found to carry a whopping 252% higher risk of leading to miscarriage.

These findings agree with a 2019 Canadian study that also found short- and long-acting benzodiazepines increased risks of miscarriage after reviewing over 400,000 pregnancies in Canada. The consistency of results across studies underscores the need for careful consideration when prescribing benzodiazepine medications to pregnant women.

Even though Dr. Zhuk recognizes that lorazepam is considered the safer benzodiazepine medication during pregnancy, based on existing safety data, both Dr. Zhuk and Dr. Hsiao urge caution. They suggest the potential risk of miscarriage should be a critical factor in deciding whether to use anxiety medications during pregnancy.

Dr. Hsiao recommends a tailored approach rather than a blanket recommendation for any specific benzodiazepine, stressing the importance of individual risk-to-benefit assessments.

Similarly, Dr. Zhuk suggests considering alternative approaches for treating anxiety or sleep disorders in those who are planning to become pregnant or who are already pregnant, which highlights the need to explore these options early on.

Reference:

Meng, Lin-Chieh, et al. “Benzodiazepine Use During Pregnancy and Risk of Miscarriage.” JAMA Network, 27 Dec 2023.