Benzodiazepines During Pregnancy Increase Odds of Miscarriage by Almost 70 Percent: Study

Benzos are commonly prescribed for anxiety, insomnia, and muscle spasms

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Popping common anti-anxiety meds such as Xanax or Diazepam while pregnant could lead to heartbreak.

A new study of more than 3 million pregnancies links benzodiazepines to a staggering 69 percent increased risk of miscarriage.

Study Highlights the Urgency for Caution

Benzodiazepines, commonly referred to as benzos, are medications that slow down brain activity and the nervous system. They include drugs such as Ativan, Xanax, Valium Klonopin, and Halcion, which are tightly regulated and only available via prescription. Doctors often prescribe benzos to treat anxiety disorders, alcohol withdrawal symptoms, seizures, and insomnia.

To gauge miscarriage risk, researchers analyzed more than 3 million Taiwanese pregnancies between 2004 and 2018 using national databases. They compared 2 million women’s records, with participants averaging 30 years old.

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Specifically, scientists looked at fetal benzodiazepine exposure one to 28 days before miscarriage. They used two comparison reference periods—31 to 58 days (or four to eight weeks) and 181 to 208 days (or 26 to 30 weeks)—before the pregnant woman’s last menstrual cycle. By overlaying benzodiazepine usage data, researchers could pinpoint associated miscarriage rates.

Results showed 4.4 percent of studied pregnancies ended in miscarriage, defined in the study as pregnancy loss occurring between eight and 19 weeks of gestation.

While all benzodiazepines raised miscarriage odds, some posed higher risks. The sleep aid fludiazepam carried the highest risk while alprazolam, more commonly known as Xanax, carried the lowest risk.

• Lorazepam (Ativan): 42 percent increased risk of miscarriage
• Alprazolam (Xanax): 39 percent increased risk of miscarriage
• Diazepam (Valium): 69 percent increased risk of miscarriage
• Oxazolam (Serax): 54 percent increased risk of miscarriage
• Fludiazepam (Erispan) (not approved for use in the United States): 252 percent increased risk of miscarriage

“These findings underscore 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,” the authors wrote.

The new study validates previous research suggesting benzodiazepine usage in pregnancy elevates miscarriage risk. For example, a 2012 UK study found higher rates of both miscarriage and perinatal death among expectant mothers taking psychotropic medications. Specifically, benzodiazepines and less common prescriptions, as well as multiple drug classes combined, showed the strongest associations with adverse outcomes.

Family Planning Essential While On Medications

It’s common for women to take medications during pregnancy. However, expectant mothers and women thinking about becoming pregnant should consult their doctor or OBGYN if they are on psychotropic or other drugs that may impact a fetus.

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There are still significant questions about medication safety in pregnancy, according to the U.S. Centers for Disease Control and Prevention. One reason data is limited is pregnant women are rarely included in clinical trials determining new drug risks.

While some medications are known to cause birth defects, others like benzodiazepines heighten miscarriage odds.

Common medications to avoid during pregnancy include:

• Aspirin and ibuprofen during pregnancy, unless explicitly doctor-prescribed
• Over-the-counter supplements such as herbs, mineral blends, regular strength vitamins, and aspirin complexes
• High-risk acne prescription isotretinoin (sold as Absorica, Amnesteem, Accutane, Roaccutane and under many other names)
• Thalidomide for select skin diseases and blood cancers

The risks of fetal exposure to isotretinoin are so significant that a special program, iPledge, is administered to ensure no pregnant woman takes the drug and no woman taking the drug becomes pregnant.

Women who are taking any of these medications should consult their doctor on safer medication options or the necessity of continuing treatment. Health care providers may be able to provide an alternative medication that is safe for both for the mother and the developing baby.