Antipsychotics During Pregnancy

Bodén, Robert; Lundgren, Maria; Brandt, Lena; Reutfors, Johan; Kieler, Helle

doi:10.1001/archgenpsychiatry.2011.1870

Cited by 117 publications

(46 citation statements)

References 29 publications

(45 reference statements)

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“…Thirteen cohort studies, including 6,289 antipsychotic-exposed and 1,618,039 unexposed pregnancies and 6 057 antipsychotic-exposed and 1 641 187 unexposed infants during pregnancy, were eligible for inclusion in this review (Table 1). Three studies were derived from the same population-based cohort(17–19) and data from one study were subsequently published as a book(20, 21); therefore, the study reporting the largest population for each outcome was used. All included studies were cohort studies with data derived from birth registries and teratology information services (TIS).…”

Section: Resultsmentioning

confidence: 99%

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Obstetric and Neonatal Outcomes After Antipsychotic Medication Exposure in Pregnancy

Coughlin

Blackwell²,

Bartley³

et al. 2015

Obstetrics &Amp; Gynecology

107

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Objective Antipsychotic medications are used by increasing numbers of women of reproductive age. The safety of these medications during pregnancy has not been well-described. We undertook a systematic review and meta-analysis of the adverse obstetric and neonatal outcomes associated with exposure to antipsychotics during pregnancy. Data Sources PubMed, Reprotox, and ClinicalTrials.gov were searched to identify potential studies for inclusion. Methods of Study Selection Case-control or cohort studies estimating adverse birth outcomes associated with antipsychotic exposure during pregnancy were included. Pooled odds ratios (OR) were used for dichotomous outcomes and weighted mean differences (WMD) were used for infant birth weight and gestational age. Thirteen cohort studies, including 6,289 antipsychotic-exposed and 1,618,039 unexposed pregnancies were included. Tabulation, Integration, and Results Antipsychotic exposure was associated with an increased risk of major malformations (Absolute Risk Difference = 0.03, 95% confidence interval [CI] 0.00 – 0.05, p=0.04, Z = 2.06), heart defects (Absolute Risk Difference =0.01, 95% CI 0.00 – 0.01, p<0.001, Z = 3.44), preterm delivery (Absolute Risk Difference = 0.05, 95% CI 0.03 – 0.08, p<0.001, Z = 4.10), small-for-gestational-age births (Absolute Risk Difference = 0.05, 95% CI 0.02 – 0.09, p = 0.006, Z = 2.74), elective termination (Absolute Risk Difference = 0.09, 95% CI 0.05 – 0.13, p<0.001, Z = 4.69) and decreased birth weight (WMD=−57.89g, 95%CI −103.69g – −12.10g, p=0.01). There was no significant difference in the risk of major malformations (test for subgroup differences: χ2 = 0.07, df = 1, p = 0.79) between typical (OR = 1.55, 95% CI 1.21 – 1.99, p = 0.006) and atypical (OR = 1.39, 95% CI 0.66 – 2.93, p = 0.38) antipsychotic medications. Antipsychotic exposure was not associated with risk of large for gestational age births, stillbirth, and spontaneous abortion. Although antipsychotic exposure during pregnancy was associated with increased risk of adverse obstetric and neonatal outcomes, this association does not necessarily imply causation. This analysis was limited by the small number of included studies and limited adjustment in studies for possible confounders. Conclusion Women requiring antipsychotic treatment during pregnancy appear at higher risk of adverse birth outcomes, regardless of causation, and may benefit from close monitoring and minimization of other potential risk factors during pregnancy.

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Section: Resultsmentioning

confidence: 99%

“…Three studies reported mean gestational age,(13, 17, 26) which included 730 antipsychotic-exposed and 357 947 unexposed infants. Infants exposed to antipsychotics were born earlier than unexposed infants, but this effect on gestational age was not statistically significant (Figure 4B; WMD = −0.21wks, 95% CI −0.44wks – 0.01wks, p = 0.06).…”

Section: Resultsmentioning

confidence: 99%

Obstetric and Neonatal Outcomes After Antipsychotic Medication Exposure in Pregnancy

Coughlin

Blackwell²,

Bartley³

et al. 2015

Obstetrics &Amp; Gynecology

107

View full text Add to dashboard Cite

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“…49 Another study also using Swedish registry data, but from 2005 to 2009 estimated atypical antipsychotic use during pregnancy to be approximately 0.1%. 50 We found that quetiapine, olanzapine and risperidone were the three most commonly prescribed atypical antipsychotics both before and after pregnancy. This mirrors the patterns of atypical antipsychotics dispensed in the USA 37 and the general prescribing pattern of antipsychotics in the UK.…”

Section: Psychotropic Medication Prescribed Before During and After mentioning

confidence: 87%

“…Other research on antipsychotic treatment in pregnancy includes pharmacovigilance studies from drug companies' safety databases 76,77 as well as cohort studies based on various data sources. 38,50,[78][79][80][81][82][83][84][85] A systematic review 19 of many of these studies suggested that women requiring antipsychotic treatment during pregnancy have a higher risk of adverse birth outcomes. However, there was substantial heterogeneity between the studies and Coughlin et al 19 emphasise that most studies had limited adjustment for potential confounding and therefore the observed associations may not be causal.…”

Section: Antipsychoticsmentioning

confidence: 99%

Risks and benefits of psychotropic medication in pregnancy: cohort studies based on UK electronic primary care health records

Petersen

McCrea

Sammon

et al. 2016

Health Technol Assess

133

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BackgroundAlthough many women treated with psychotropic medication become pregnant, no psychotropic medication has been licensed for use in pregnancy. This leaves women and their health-care professionals in a treatment dilemma, as they need to balance the health of the woman with that of the unborn child. The aim of this project was to investigate the risks and benefits of psychotropic medication in women treated for psychosis who become pregnant.Objective(s)(1) To provide a descriptive account of psychotropic medication prescribed before pregnancy, during pregnancy and up to 15 months after delivery in UK primary care from 1995 to 2012; (2) to identify risk factors predictive of discontinuation and restarting of lithium (multiple manufacturers), anticonvulsant mood stabilisers and antipsychotic medication; (3) to examine the extent to which pregnancy is a determinant for discontinuation of psychotropic medication; (4) to examine prevalence of records suggestive of adverse mental health, deterioration or relapse 18 months before and during pregnancy, and up to 15 months after delivery; and (5) to estimate absolute and relative risks of adverse maternal and child outcomes of psychotropic treatment in pregnancy.DesignRetrospective cohort studies.SettingPrimary care.ParticipantsWomen treated for psychosis who became pregnant, and their children.InterventionsTreatment with antipsychotics, lithium or anticonvulsant mood stabilisers.Main outcome measuresDiscontinuation and restarting of treatment; worsening of mental health; acute pre-eclampsia/gestational hypertension; gestational diabetes; caesarean section; perinatal death; major congenital malformations; poor birth outcome (low birthweight, preterm birth, small for gestational age, low Apgar score); transient poor birth outcomes (tremor, agitation, breathing and muscle tone problems); and neurodevelopmental and behavioural disorders.Data sourcesClinical Practice Research Datalink database and The Health Improvement Network primary care database.ResultsPrescribing of psychotropic medication was relatively constant before pregnancy, decreased sharply in early pregnancy and peaked after delivery. Antipsychotic and anticonvulsant treatment increased over the study period. The recording of markers of worsening mental health peaked after delivery. Pregnancy was a strong determinant for discontinuation of psychotropic medication. However, between 40% and 76% of women who discontinued psychotropic medication before or in early pregnancy restarted treatment by 15 months after delivery. The risk of major congenital malformations, and neurodevelopmental and behavioural outcomes in valproate (multiple manufacturers) users was twice that in users of other anticonvulsants. The risks of adverse maternal and child outcomes in women who continued antipsychotic use in pregnancy were not greater than in those who discontinued treatment before pregnancy.LimitationsA few women would have received parts of their care outside primary care, which may not be captured in this analysis. Likewise, the analyses were based on prescribing data, which may differ from usage.ConclusionsPsychotropic medication is prescribed before, during and after pregnancy. Many women discontinue treatment before or during early pregnancy and then restart again in late pregnancy or after delivery. Our results support previous associations between valproate and adverse child outcomes but we found no evidence of such an association for antipsychotics.Future workFuture research should focus on (1) curtailing the use of sodium valproate; (2) estimating the benefits of psychotropic drug use in pregnancy; and (3) investigating the risks associated with lifestyle choices that are more prevalent among women using psychotropic drugs.Funding detailsThe National Institute for Health Research Health Technology Assessment programme.

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“…As our knowledge of the effects of exposure to the newer antipsychotics during pregnancy is limited, Boden et al [9] investigated the effects of maternal use of antipsychotics during pregnancy on gestational diabetes and fetal growth in a population-based cohort study comparing women exposed and not exposed to antipsychotics during pregnancy. They used the Swedish national health registers for all women giving birth in Sweden between July 1, 2005 and December 31, 2009, with exposure to antipsychotics defined as prescriptions filled.…”

Section: Treatment Of Schizophreniamentioning

confidence: 99%

Clinical Factor 2012

Balon¹

2013

Psychother Psychosom

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Antipsychotics During Pregnancy

Cited by 117 publications

References 29 publications

Obstetric and Neonatal Outcomes After Antipsychotic Medication Exposure in Pregnancy

Obstetric and Neonatal Outcomes After Antipsychotic Medication Exposure in Pregnancy

Risks and benefits of psychotropic medication in pregnancy: cohort studies based on UK electronic primary care health records

Clinical Factor 2012

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