Anti-Anxiety Meds Before Conception Tied to Ectopic Pregnancy | MedPage Today
Ectopic pregnancy was associated with benzodiazepine use before conceiving a child, according to a cohort study.
The risk of ectopic pregnancy was nearly 50% higher among women taking benzodiazepines in the 90 days before conception (RR 1.47, 95% CI 1.32-1.63), reported Elizabeth Wall-Wieler, PhD, of Stanford University in Palo Alto, California, and colleagues.
Benzodiazepine use among women with an anxiety diagnosis in the 9 months before conception was also linked to increased risk (IPT-weighted RR 1.34, 95% CI 1.18-1.53). This suggests that some of the association between benzodiazepine use before conception and ectopic pregnancy may be explained by conditions being treated, authors wrote in .
“A 50% increase is pretty substantial,” Wall-Wieler said in an interview with MedPage Today. “It’s important for both clinicians and for women to understand how their treatment options could be affecting their reproductive outcomes.”
Wall-Wieler said that benzodiazepines have a relaxing effect on smooth muscle, or may directly target GABA receptors in the fallopian tubes. This may affect embryo-tubal transport, which is facilitated through smooth muscle contractions and ciliary beating, the authors wrote.
“I think there is some biological plausibility that benzodiazepines could potentially affect tubal function, which we know is a factor in ectopic pregnancy,” said Jennifer Robinson, MD, of Johns Hopkins School of Medicine in Baltimore.
But Robinson, who was not involved in the study, added that these data suggest an association, not causality. She said more information about the time between when a patient took the medication and when the pregnancy occurred would lead to better understanding about associated risk.
“I’m not sure that the findings are large enough to change prescription practices,” Robinson told MedPage Today. “I would want more information before I change my practice.”
Around 1%-2% of pregnancies in the United States each year are ectopic, study authors wrote. While several risk factors have been identified — including intrauterine device (IUD) or reproductive technology use, pelvic infection, and smoking — approximately half of women who have an ectopic pregnancy have no known risk factors.
Benzodiazepine use during pregnancy has been associated with increased miscarriage and adverse birth outcomes; however, there are no known associations with ectopic pregnancy. Wall-Wieler and colleagues conducted a large cohort study to investigate whether benzodiazepine prescriptions leading up to conception were associated with this outcome.
The group identified nearly 1.7 million pregnancies from 2008 to 2015, from a database of employer-based insurance claims in the U.S.
Women exposed to benzodiazepines before pregnancy were defined as having at least two 10-day supply prescriptions in the 90 days before their estimated conception date. As gestational age was not available in the dataset, researchers used an algorithm to estimate the last menstrual period, and conception was defined as 14 days after that estimated date.
Wall-Wieler and colleagues adjusted for confounders including age at the end of pregnancy, year, and risk factors for an ectopic pregnancy, including pelvic infections, sexually transmitted infections (STIs), assisted reproductive technology, IUDs, and smoking.
Nearly 2% of all pregnancies were ectopic, and almost 18,000 were exposed to at least one benzodiazepine prescription before conception. Women who were older at the time of pregnancy; had an STI, pelvic infection, or IUD; used assisted reproductive technology; or had a smoking-related diagnosis or procedure 9 months before the exposure were more likely to have been prescribed benzodiazepines.
There were 80 more ectopic pregnancies per 10,000 pregnancies among women exposed to benzodiazepines before conception, compared with those who were not.
Wall-Wieler’s group also found that three of the most commonly used benzodiazepines — alprazolam, lorazepam, and diazepam — all had substantially higher associations with ectopic pregnancy. Clonazepam, however, was an exception.
The unweighted risk of ectopic pregnancy was higher for women prescribed benzodiazepines who had an insomnia diagnosis in the year before conception. But the IPT-weighted risk was not significantly higher among women exposed to benzodiazepines compared with women who were not exposed (weighted RR 1.28, 95% CI 0.99-1.68).
Wall-Wieler and colleagues recognized that the study is limited by the inability to validate estimates of last menstrual period and conception time. The group added that reliance on patient prescription data could result in misclassification of benzodiazepine consumption.
Amanda D’Ambrosio is a reporter on MedPage Today’s enterprise & investigative team. She covers obstetrics-gynecology and other clinical news, and writes features about the U.S. healthcare system.
This study was supported in part by a Banting Postdoctoral Fellowship, the Stanford Maternal and Child Health Research Institute, and the Canadian Network for Observational Effect Drug Studies.
Wall-Wieler and colleagues disclosed no conflicts of interest.
This content was originally published here.