Benzodiazepines Carry Increased Risk for Miscarriage

By Kelly Young

Edited by Susan Sadoughi, MD, and Richard Saitz, MD, MPH, FACP, DFASAM

Benzodiazepine use in early pregnancy is associated with increased risk for spontaneous abortion, according to a study in JAMA Psychiatry. Benzodiazepines are category D drugs, meaning there is evidence of human fetal harm.

Using Canadian healthcare databases, researchers matched 27,000 cases of spontaneous abortion occurring between the 6th and 19th week of gestation with 134,000 control pregnancies. Rates of benzodiazepine use (defined by prescription fills) were significantly higher among spontaneous abortion cases than controls (1.4% vs. 0.6%). Higher benzodiazepine doses were associated with greater risks.

The drugs conferring the highest risk were diazepam, temazepam, bromazepam (not approved in the U.S.), and alprazolam.

The authors conclude: "The findings suggest that health care clinicians should carefully evaluate the risk-benefit ratio of benzodiazepines for the treatment of insomnia and mood or anxiety disorders in early pregnancy. Alternative nonpharmacologic treatments exist and are recommended, but if benzodiazepines are needed, they should be prescribed for short durations."