In Reply Although we agree with Wisner and Yonkers that our findings1 can potentially be explained by residual confounding by indication, we have performed several additional sensitivity analyses to validate our results. First, the impact of the diseases for which benzodiazepines are prescribed was addressed in the main analysis where statistical adjustments were made for the diagnoses of the 2 main indications (mood and anxiety disorders and insomnia) and documented proxies of these diseases (concomitant exposure to antidepressants and/or antipsychotics, psychiatrist visits, comorbidities, and emergency department visits and/or hospitalizations in the year before pregnancy). Second, additional sensitivity analyses were performed restricting the study population to pregnant women with history of mood and anxiety disorders, where incident benzodiazepine use during early pregnancy was associated with an even higher risk of spontaneous abortion (adjusted odds ratio [aOR], 2.85; P < .05). These findings suggest that incident use of benzodiazepines in early pregnancy is associated with an increased risk of spontaneous abortion above and beyond the risk for maternal stress or depression.
Identify all potential conflicts of interest that might be relevant to your comment.
Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.
Err on the side of full disclosure.
If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.
Not all submitted comments are published. Please see our commenting policy for details.
Sheehy O, Zhao J, Bérard A. Are Adverse Reproductive Outcomes Associated With the Illness or Its Treatment (or Both)?—Reply. JAMA Psychiatry. 2019;76(12):1318. doi:10.1001/jamapsychiatry.2019.2448
Coronavirus Resource Center
Customize your JAMA Network experience by selecting one or more topics from the list below.
Create a personal account or sign in to: