2023-12-27 18:08:37
Updated Wednesday, December 27, 2023 – 17:08
An analysis of more than three million pregnancies reveals a potential relationship between the use of these medications and spontaneous abortion
Pregnant woman with a pillShutterstock
Anxiety and insomnia are two disorders that can appear during pregnancy; In both pathologies, the benzodiazepines for its anxiolytic and hypnotic action. In fact, a 2021 study in the United States found that these drugs They are prescribed in 1.7% of pregnant women during the first trimester of pregnancy
But could these medications be behind cases of spontaneous abortion? It is the question from which new research that has just been published in JAMA Psychiatryand which concludes with the warning against the use of these drugs at the beginning of pregnancy.
“Benzodiazepines can easily cross the placental barrier and accumulate substantially in embryonic and fetal tissues,” write the authors of this study, led by Lin-Chieh Mengfrom the Hospital Pharmacy Service of the National Taiwan University.
A PLAUSIBLE EFFECT
“Given its potential role in cell proliferation and differentiation processes, it is plausible that Benzodiazepines may cause abnormalities in fetal developmentwhich ultimately leads to spontaneous abortion,” they argue.
On this premise, the researchers analyzed in a case-control study 3,067,122 pregnancies, which in a percentage of 4.4% (135,134) resulted in abortion. The data analyzed came from two sources: the Taiwanese Social Security Institute (with information from 2002 to 2019) and the National Birth Registry database (between 2004 and 2018).
Women exposed to benzodiazepines during pregnancy had a 85% higher risk of miscarriageonce other possible medical factors – such as certain comorbidities and genetic determinants – have been taken into account, in addition to sociodemographic factors, including economic level and lifestyle.
For the researchers, these results justify “the Caution in the use of benzodiazepines during the early stages of pregnancy. The findings of this study also provide evidence to guide physicians in making informed decisions about the treatment of psychiatric and sleep disorders in pregnant women. “Prescribing benzodiazepines should only be considered after a thorough assessment of the potential benefits and risks to both mother and child.”
The limitation that can arise from a case-control study is the first thing highlighted by an expert consulted by SMC of the United Kingdom to evaluate the study. Simon Wesselyprofessor of psychiatry at King’s College London, wonders whether the association is really causal: “Is this cause and effect? The problem is that we cannot affirm it. There may be many reasons why someone prescribed benzodiazepines also has a higher risk of miscarriage. “They did their best to control for those factors, and the association persisted, but it’s always a problem in these types of studies.”
CAUTION IN PRESCRIPTION
However, he agrees with the authors of the work that “the main lesson is that, for many reasons, we must continue with all the efforts to reduce benzodiazepine prescriptions, especially for longer periods.”
He is also a psychiatrist Christian Vinkersfrom the Medical Center of the University of Amsterdam, also refers to the methodology of the work: “This is a very large case-control study, but I believe that these results have a great risk of confusion by indication, that is, that patients with mental health problems receive more benzodiazepines“, comments SMC.
He also argues that the study “should not change standard practice” as it does not show a “plausible mechanism.” He notes that “benzodiazepine use is defined very broadly, and narrower definitions lead to attenuated associations.”
However, Vinkers considers it necessary to Cautious attitude with the use of any medication during pregnancy. Although, “there is no doubt that anxiety and severe insomnia also have detrimental effectss for the mother and the fetus”.
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