Sedatives dramatically increased the risk of miscarriage in pregnant women
Women in pregnancy often suffer from sleep and mental disorders. Benzodiazepine sedatives and sedatives, popular in many countries, can help with these conditions. Doctors prescribe them, including to pregnant women, for complaints of insomnia and anxiety. However, a large study in Taiwan has shown that taking such drugs can lead to premature termination of pregnancy.
Benzodiazepines belong to the group of central nervous system depressants and have soporific, sedative and anxiety-reducing effects. Among the most prescribed pharmaceuticals of this class are alprazolam, diazepam, lorazepam, oxazolam and fludiazepam.
As in the case of many other medications, the instructions for such drugs have a warning about contraindication in pregnancy. However, this apparently does not prevent the widespread use of benzodiazepines. A recent meta-analysis of 32 scientific papers showed that such drugs are prescribed to women in pregnancy in 28 countries, and the prevalence of their use during pregnancy in the world is estimated at almost 2%. Lorazepam and similar drugs are most commonly prescribed in Eastern Europe.
Randomized clinical trials are not well suited for assessing the safety of benzodiazepines in pregnant women, as such patients are usually not allowed to participate. Therefore, a team of scientists from Taiwan opted for an observational study using a case-control - time-control design to remove the influence of measurable and unmeasurable distorting factors.
In the paper, published in the journal JAMA Psychiatry, the researchers reviewed information from Taiwan's national databases on more than three million pregnancies in 1,957,601 women from 2002 through 2019. A small but significant proportion of these - 136,134 pregnancies, or 4.4 percent - ended in miscarriages. The average age of the women in the sample was just over 30 years.
The incidence of premature termination of pregnancy was studied in more detail. Researchers compared how often miscarriages occurred in women who did or did not use benzodiazepines while carrying a fetus. Various variables were considered in the analysis, including demographic characteristics and comorbidities prior to pregnancy. An analysis adjusting for distorting factors showed that pregnant women's use of benzodiazepines correlated with an average 69% increased risk of fetal non-pregnancy.
In addition, the researchers found that some types of benzodiazepines, such as fludiazepam, increased the likelihood of miscarriage much more than others - by a factor of 2.52. The dosage of sedatives also played a role: with a low dose of benzodiazepines the risk increased by 61%, and with a high dose - already by 86%.
Summing up, the researchers emphasized that their results indicate the need to carefully weigh the risk and benefit when prescribing pregnant women drugs for the treatment of mental disorders and sleep disorders.
However, Professor Simon Wessely (Simon Wessely) from King's College London in a comment to The Telegraph said that, despite the impressive sample size and the correlation found, the question of causation remained open. However, the doctor agreed that doctors should in any case try to prescribe benzodiazepines less frequently and for as short a time as possible.