Neonatal morbidity after fetal exposure to antipsychotics: a national register-based study

Abstract

ObjectiveTo investigate the admission rate to neonatal care and neonatal morbidity after maternal use of antipsychotics during pregnancy.DesignA population-based register study.SettingInformation on all singleton births between July 2006 and December 2017 in Sweden including data on prescription drugs, deliveries and infants’ health was obtained from the Swedish Medical Birth Register, the Prescribed Drug Register and the Swedish Neonatal Quality Register. Exposed infants were compared with unexposed infants and with infants to mothers treated with antipsychotics before or after but not during pregnancy.ParticipantsThe cohort comprised a total of 1 307 487 infants, of whom 2677 (0.2%) were exposed to antipsychotics during pregnancy and 34 492 (2.6%) had mothers who were treated before/after the pregnancy.Outcome measuresThe primary outcome was admission rate to neonatal care. Secondary outcomes were the separate neonatal morbidities.ResultsOf the exposed infants, 516 (19.3%) were admitted to neonatal care compared with 98 976 (7.8%) of the unexposed infants (adjusted risk ratio (aRR): 1.7; 95% CI: 1.6 to 1.8), with a further increased risk after exposure in late pregnancy. The highest relative risks were seen for withdrawal symptoms (aRR: 17.7; 95% CI: 9.6 to 32.6), neurological disorders (aRR: 3.4; 95% CI: 2.4 to 5.7) and persistent pulmonary hypertension (aRR: 2.1; 95% CI: 1.4 to 3.1) when compared with unexposed infants. The absolute risks for these outcomes were however low among the exposed infants, 1.3%, 1.8% and 1.0%, respectively, and the relative risks were lower when compared with infants to mothers treated before/after the pregnancy.ConclusionFetal exposure to antipsychotics was associated with an increased risk of neonatal morbidity. The effects in the exposed infants seem transient and predominantly mild, and these findings do not warrant discontinuation of a necessary treatment but rather increased monitoring of these infants. The increased risk of persistent pulmonary hypertension requires further studies.

Outcomes of long-acting injectable antipsychotics use in pregnancy: A literature review

“…Determining whether the outcomes are due to illness or medication factors (class of medication or long-acting formulations) remains an ongoing problem in this area[ 20 ]. In addition, some studies on the use of oral antipsychotics during pregnancy indicate a possible increased risk for complications like gestational diabetes[ 55 - 59 ], preterm birth[ 56 , 60 - 62 ], congenital malformations[ 63 - 65 ], withdrawal symptoms[ 66 ], and neonatal hospitalization[ 66 - 69 ]. Nevertheless, many of these findings have not been consistent across studies[ 60 , 62 , 70 - 75 ].…”

An Obstetric and Psychiatric Emergency: Managing Acute Agitation Among Pregnant Patients in the Emergency Department

“…Antipsychotic exposure during the first trimester is thought to potentially increase the risk of congenital malformations (Edinoff et al, 2022), whereas exposing women in the third trimester increases the associated risk of neonatal morbidity (Heinonen, Forsberg, Nörby, Wide, & Källén, 2022). However, neonatal disorders related to antipsychotic use in late pregnancy seem predominantly mild, and transient, frequent monitoring of exposed infants is recommended rather than cessation of its necessary use (Heinonen et al, 2022). In summary, the degree of the teratogenic effect remains low and findings do not warrant the discontinuation of neuroleptic use in the acute setting (Heinonen et al, 2022; Niforatos et al, 2019; Rodriguez-Cabezas & Clark, 2018).…”

“…However, neonatal disorders related to antipsychotic use in late pregnancy seem predominantly mild, and transient, frequent monitoring of exposed infants is recommended rather than cessation of its necessary use (Heinonen et al, 2022). In summary, the degree of the teratogenic effect remains low and findings do not warrant the discontinuation of neuroleptic use in the acute setting (Heinonen et al, 2022; Niforatos et al, 2019; Rodriguez-Cabezas & Clark, 2018). The clinician should continue prompt management of moderate and severe agitation using psychotropic agents when needed.…”

“…Unlike the newer atypical antipsychotic agents, FGAs have extensive well-controlled studies over decades to assess for potential teratogenicity (Edinoff et al, 2022). Antipsychotic exposure during the first trimester is thought to potentially increase the risk of congenital malformations (Edinoff et al, 2022), whereas exposing women in the third trimester increases the associated risk of neonatal morbidity (Heinonen, Forsberg, Nörby, Wide, & Källén, 2022). However, neonatal disorders related to antipsychotic use in late pregnancy seem predominantly mild, and transient, frequent monitoring of exposed infants is recommended rather than cessation of its necessary use (Heinonen et al, 2022).…”