Antipsychotics Appear Safe During Pregnancy

By David Douglas

NEW YORK - Use of antipsychotic drugs during pregnancy does not increase the risk of maternal metabolic and other complications, according to Canadian researchers.

As Dr. Simone N. Vigod of the University of Toronto told Reuters Health by email, "More women are using antipsychotic medication during pregnancy to maintain their mental health, but relatively little is known about the impact of using antipsychotic medication during pregnancy on the medical health of mother and baby."

In a May 13 online paper in the BMJ, Dr. Vigod and colleagues noted that they studied 1,021 women in Ontario who used antipsychotic medication during pregnancy, and compared them to 1,021 very similar women with respect to medical and psychiatric history who did not.

Most women were using the newer, second-generation, atypical antipsychotic medications (i.e. quetiapine, risperidone, olanzapine). Overall, the rates of maternal medical conditions during pregnancy, including gestational diabetes, gestational high blood pressure, and blood clots, were similar between groups.

"Similarly," continued Dr. Vigod, "rates of important pregnancy outcomes such as prematurity and infant size did not differ between groups. While we did not study long-term child outcomes, this information is reassuring for women who require antipsychotic medication during pregnancy for their mental health stability."

"Of note," she added, "while the two groups of women that we studied did not differ with respect to their outcomes, rates of certain conditions such as preterm birth were more common among women using antipsychotic medication than would be expected in the general population."

In fact, although the preterm birth rate was high among antipsychotic users (14.5%) and matched non-users (14.3%), it was not relatively different.

The results are reassuring in the short term, but Dr. Vigod concluded that the findings suggest that "women using antipsychotic medication in pregnancy do require close monitoring and attention to other potentially modifiable health factors that will optimize their health and that of their children."

Commenting on the findings by email, pharmacoepidemiologist Dr. Anders Hviid told Reuters Health that this was "an interesting study trying to disentangle the effects of anti-psychotic drug use in pregnancy from the effects of the underlying psychotic disorders on maternal and fetal health in pregnancy."

"A novel aspect of the study," he added, "is the use of a summary score for each woman in the study, incorporating as much health information as possible from many registers. This has allowed the researchers to address the fact that women with psychotic disorders are not directly comparable to women from a general population when it comes to health issues."

Dr. Hviid, of the Statens Serum Institute, Copenhagen, Denmark, added, "The Canadian researchers conclude that antipsychotic drug use in itself does not pose a significant risk to the mother or child. However, the study is not large, mainly because antipsychotic drug use in pregnancy is not common, and as such the study can only exclude moderate to large negative effects."

The Canadian Institutes of Health Research and the Institute for Clinical and Evaluative Sciences supported this research. The authors reported no disclosure for this study.

SOURCE: https://bmj.co/1Ahsw5J

BMJ 2015.

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