In a recent study by the National Taiwan University in Taipei, researchers have identified the link between benzodiazepine use and miscarriage risk [1]. This research mimics similar studies done worldwide that bring awareness to the impacts Schedule IV prescription drugs have on maternal health and child development [1]. Although this study illustrates important concerns regarding careful use of benzodiazepine medications during pregnancy, it also discusses the unbalanced lack of prioritization of maternal wellbeing and the overprescription of Schedule IV drugs for women.
The study itself was a case-time-control study that used Taiwan’s National Birth Certificate Application and National Health Insurance databases to find the relationship between miscarriages and gestational benzodiazepine use from 2004 to 2018 [1]. Ultimately, the data they collected showed that both long and short-acting benzodiazepine use increased miscarriage risk by 69% [2].
Benzodiazepines are used to treat anxiety, muscle spasms, and seizures [3]. They signal your brain’s release of the inhibitory neurotransmitter GABA, which blocks the formation of new memories, reduces anxiety, and functions as a sedative [3]. Long-acting benzodiazepines may last several days, whereas short-acting benzodiazepines may last a few hours. Common brand names include Xanax, Klonopin, Valium, and Ativan [3].
In another study done by the Yale School of Medicine, it was shown that using benzodiazepines during pregnancy increases C-section births by 2.5 times, and babies were 3 times more likely to need ventilatory support [4]. Benzodiazepines have also been linked to congenital disabilities and conditions including cleft lip and palate, low birth weight, low muscle tone, respiratory distress, and preterm birth [4]. Preterm birth can lead to neurodevelopmental abnormalities, poorly formed lungs, heart, or other organs [5]. Low birth weight and muscle tone can lead to consequences including delayed growth and speech, and difficulty feeding to name a few [6].
In addition to these acute dangers of benzodiazepine use after birth, there is also potential for those taking long-acting benzodiazepines to have children subjected to withdrawal, experiencing irritability, poor sleep, restlessness, depression, tremors, and seizures [7]. Benzodiazepines can also be present in breast milk, and although infants may not be able to consume a significant amount of the drug, there is still a risk of showing signs that they are ingesting high levels of the drug [7]. Therefore, these drugs can not only be habit forming, and increase risk of miscarriage, but they may also present additional health dangers to the newborn.
These concerns brought up surrounding benzodiazepine use are critical in evaluating the broader role of medicine in the administration and overprescription of Schedule IV drugs. The standard in the United States is to not prescribe benzodiazepine-containing medications for more than two weeks, however, this guidance is not always followed and can still lead to dependence [8]. In 2013, benzodiazepines were implicated in 30% of overdose deaths, and the number of prescriptions filled for these drugs increased by 30% from the 90s [8]. The increase in benzodiazepine prescriptions and prevalence in substance abuse disorders parallels the opioid crisis. In a study performed in 2019, 25.3 million people reported benzodiazepine use, with 5.3 million of those individuals reporting misuse [8]. Because of this, there is a substantial demographic of vulnerable individuals that may be forced to rapidly stop these drugs after finding out they are pregnant. Withdrawal can include panic attacks, psychosis, delirium, seizures, weakness, and hallucinations which can both impact the development of the fetus, in addition to the wellbeing of the mother. [7] There is a pattern of dependence that results from an overmedicalization of various disorders and mental health issues, instead of offering holistic support.
The stress of going through withdrawals, or not being able to take anxiety medications, can have detrimental birth outcomes including increased maternal risk of perinatal depression, which can impact the mother-infant bond. It can also alter postnatal care through reduced breast feeding, and abnormal behavioral development of the child. Additionally, this type of stress can increase risks of conotruncal heart defects, neural tube defects, cleft lips, preterm labor, preeclampsia, gestational diabetes, and preterm delivery that jeopardize the health of both the mother and the child [9]. Ultimately, this brings up the question of if inducing this level of stress outweighs the potential physiological risks that come with benzodiazepine use.
Although nobody is objecting to the validity of the importance of close monitoring of medications during pregnancy, it is important to evaluate the prioritization of maternal well being. At what point does the fetus’ wellbeing supersede that of the pregnant woman? This issue illuminates the poor management and support for women that has led to the overprescription of these highly-addictive medications,which are then misused.
It is important to not only direct this research towards medical professionals to be more aware of the long term effects of benzodiazepines, but also to reevaluate how we view motherhood. It is important that we continue to view mothers as humans—not just robotic vessels that only have the purpose of delivering a healthy child. We must weigh the potential risks of medication use during pregnancy for each individual woman—taking an individualized, holistic approach for treatment that also acknowledges the wellbeing of the mother. Overall, illuminating the risks of benzodiazepine usage creates a new avenue of ethical debate regarding the morality and bodily autonomy that is experienced with motherhood. Where does the mother end and the fetus begin? Can the mother safely use these medications while also prioritizing the health of her child?
1. DePeau-Wilson, M. (2023, December 27). Benzodiazepine use in pregnancy tied to miscarriage risk. MedPage Today. https://www.medpagetoday.com/psychiatry/anxietystress/108037.
2. Pundit, B., & Pundit, B. (2023, December 28). Benzodiazepine use in pregnancy tied to miscarriage risk | Bioethics.com. Bioethics.com. https://bioethics.com/archives/74197.
3. Professional, C. C. M. (n.d.). Benzodiazepines (Benzos). Cleveland Clinic. https://my.clevelandclinic.org/health/treatments/24570-benzodiazepines-benzos.
4. Benzodiazepines & pregnancy: safety & effects on the baby. (2024, January 3). American Addiction Centers. https://americanaddictioncenters.org/benzodiazepine/can-benzodiazepines-be-used-during-pregnancy.
5. Premature birth - Symptoms and causes - Mayo Clinic. (2023, February 25). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/premature-birth/symptoms-causes/syc-20376730.
6. Muscle weakness (Hypotonia) | Boston Children’s Hospital. (n.d.). https://www.childrenshospital.org/conditions/muscle-weakness-hypotonia.
7. American Addiction Centers Editorial Staff & American Addiction Centers Editorial Staff. (2023, May 2). Are benzos overprescribed? - DrugAbuse.com. DrugAbuse.com. https://drugabuse.com/blog/are-benzos-overprescribed/#:~:text=Because%20of%20its%20highly%20addictive,as%20tolerance%20levels%20are%20reached.
8. Benzodiazepine Information Coalition. (2022, March 19). Prescribing Statistics - Benzodiazepine Information Coalition. https://www.benzoinfo.com/prescribing-statistics/.
9. Benzodiazepines & pregnancy: safety & effects on the baby. (2024, January 3). American Addiction Centers. https://americanaddictioncenters.org/benzodiazepine/can-benzodiazepines-be-used-during-pregnancy.
10. Coussons-Read ME. Effects of prenatal stress on pregnancy and human development: mechanisms and pathways. Obstet Med. 2013 Jun;6(2):52-57. doi: 10.1177/1753495X12473751. Epub 2013 May 3. PMID: 27757157; PMCID: PMC5052760.