Abstract
Objective
To assess the association between antipsychotic use in early pregnancy and the risk
of maternal and neonatal metabolic complications.
Methods
We conducted a population-based retrospective cohort study (January 1, 2010, to December
31, 2016) using the Health and Welfare Database in Taiwan. Pregnant women (18 to 49
years of age) were grouped as antipsychotic users (ie, received oral antipsychotic
monotherapy during the first 20 weeks of pregnancy) and nonusers. Antipsychotic users
were further categorized into first-generation antipsychotic and second-generation
antipsychotic users. Propensity score methods, including matching and inverse probability
of treatment weighting, were used to balance covariates. Conditional logistic regression
and Cox proportional hazards models were used to compare risks of maternal (gestational
diabetes mellitus, preterm birth) and neonatal (low birth weight [LBW], macrosomia)
outcomes.
Results
Antipsychotic users had a notably higher risk of preterm birth compared with nonusers
(adjusted HR, 1.29; 95% CI, 1.04 to 1.60), but the risk of gestational diabetes mellitus
(HR, 1.21; 95% CI, 0.94 to 1.56), LBW (odds ratio [OR], 1.07; 95% CI, 0.84 to 1.37),
and macrosomia (OR, 1.36; 95% CI, 0.63 to 2.92) did not differ between the two groups.
Among women who received antipsychotics, the odds of LBW were significantly higher
in second-generation antipsychotic users compared with first-generation antipsychotic
users (adjusted OR, 1.32; 95% CI, 1.04 to 1.68).
Conclusion
This study found that using antipsychotics in early pregnancy did not result in a
greater risk of metabolic complications both for mothers and newborns. For women requiring
treatment with antipsychotics during pregnancy, they should be monitored for the risk
of preterm birth and low infant birth weight.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Mayo Clinic ProceedingsAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Antenatal and Postnatal Mental Health: Clinical Management and Service Guidance.Updated Edition. British Psychological Society, Leicester, UK2014
- Prevalence and trends in the use of antipsychotic medications during pregnancy in the US, 2001–2007: a population-based study of 585,615 deliveries.Arch Womens Ment Health. 2013; 16: 149-157
- Psychotropic drug use before, during, and after pregnancy: a population-based study in a Canadian cohort (2001–2013).Can J Psychiatry. 2017; 62: 543-550
- Antipsychotic drug use in pregnancy: a multinational study from ten countries.Schizophr Res. 2020; 220: 106-115
Federation ID. IDF DIABETES ATLAS Eighth edition.
- Gestational diabetes from A to Z.World J Diabetes. 2017; 8: 489-511
- Gestational diabetes mellitus: risks and management during and after pregnancy.Nat Rev Endocrinol. 2012; 8: 639-649
- Hyperglycemia during pregnancy and long-term offspring outcomes.Curr Diab Rep. 2019; 19: 143
- ADIPS consensus guidelines for the testing and diagnosis of hyperglycaemia in pregnancy in Australia and New Zealand.Australasian Diabetes in Pregnancy Society. 2014; : 1-8
- Gestational diabetes mellitus in women receiving beta-adrenergics and corticosteroids for threatened preterm delivery.Obstet Gynecol. 1997; 90: 880-883
- Effects of antipsychotic medications on appetite, weight, and insulin resistance.Endocrinol Metab Clin North Am. 2013; 42: 545-563
- Molecular pathophysiology of metabolic effects of antipsychotic medications.Trends Endocrinol Metab. 2014; 25: 593-600
- Maternal use of antipsychotics in early pregnancy and delivery outcome.J Clin Psychopharmacol. 2008; 28: 279-288
- Antipsychotics during pregnancy: relation to fetal and maternal metabolic effects.Arch Gen Psychiatry. 2012; 69: 715-721
- Antipsychotic drug use in pregnancy: high dimensional, propensity matched, population based cohort study.BMJ. 2015; 350: h2298
- Pregnancy outcomes following maternal exposure to second-generation antipsychotics given with other psychotropic drugs: a cohort study.BMJ Open. 2013; 3e003062
- Continuation of atypical antipsychotic medication during early pregnancy and the risk of gestational diabetes.Am J Psychiatry. 2018; 175: 564-574
- Pregnancy outcome of women using atypical antipsychotic drugs: a prospective comparative study.J Clin Psychiatry. 2005; 66 (quiz 546): 444-449
- Use of atypical antipsychotics in pregnancy and maternal gestational diabetes.J Psychiatr Res. 2017; 95: 84-90
- Risks and benefits of psychotropic medication in pregnancy: cohort studies based on UK electronic primary care health records.Health Technol Assess. 2016; 20: 1-176
- Prevalence and risk factors of gestational diabetes mellitus in Asia: a systematic review and meta-analysis.BMC Pregnancy Childbirth. 2018; 18: 494
- Database User Manual.(Accessed August 1, 2020)
- National Health Insurance Annual Statistical Report.2019 (Accessed November 9, 2020. https://www.mohw.gov.tw/cp-4995-56604-2.html)
- The Use of Long-Acting Injectable Antipsychotics in Schizophrenia: Evaluating the Evidence.J Clin Psychiatry. 2016; 77: 1-24
- Antipsychotic polypharmacy: a comprehensive evaluation of relevant correlates of a long-standing clinical practice.Psychiatr Clin North Am. 2012; 35: 661-681
- 189 summary: nausea and vomiting of pregnancy.Obstet Gynecol. 2018; 131: 190-193
- Validation of algorithms to ascertain clinical conditions and medical procedures used during pregnancy.Pharmacoepidemiol Drug Saf. 2011; 20: 1168-1176
- Optimal caliper widths for propensity-score matching when estimating differences in means and differences in proportions in observational studies.Pharm Stat. 2011; 10: 150-161
- The performance of different propensity score methods for estimating marginal hazard ratios.Stat Med. 2013; 32: 2837-2849
- Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples.Stat Med. 2009; 28: 3083-3107
- Comparing paired vs non-paired statistical methods of analyses when making inferences about absolute risk reductions in propensity-score matched samples.Stat Med. 2011; 30: 1292-1301
- Sensitivity analysis and external adjustment for unmeasured confounders in epidemiologic database studies of therapeutics.Pharmacoepidemiol Drug Saf. 2006; 15: 291-303
- Maternal schizophrenia and pregnancy outcome: does the use of antipsychotics make a difference?.Schizophr Res. 2010; 116: 55-60
- Adherence to healthy lifestyle and risk of gestational diabetes mellitus: prospective cohort study.BMJ. 2014; 349: g5450
Article Info
Publication History
Published online: October 07, 2022
Footnotes
Grant Support: This study was supported, in part, by research grants from Ministry of Science and Technology, Taiwan (MOST 106-2320-B-038-018, and MOST 108-2320-B-038-041 to Dr Wu). The funders had no role in the study design, data collection and analysis, result interpretation, publication decision, or manuscript preparation.
Identification
Copyright
© 2022 Mayo Foundation for Medical Education and Research
