Trajectories of antipsychotic use before and during pregnancy and associated maternal and birth characteristics

Abstract

Objective: To identify distinct trajectories of antipsychotic use prior to and during pregnancy and describe the associated maternal and birth characteristics. Methods: We conducted a population-based cohort study of births (2005–2012) using linked administrative data in New South Wales, Australia. We used group-based trajectory modelling to classify trajectories of antipsychotic use in the 450 days prior to pregnancy and during pregnancy. We characterised women with different trajectories according to maternal sociodemographic characteristics, mental health diagnoses and hospitalisations, use of psychotropic medicines and birth outcomes. Results: Of 137,993 women who gave birth, 2741 (2.0%) were exposed to antipsychotics prior to or during pregnancy. We identified six trajectories of antipsychotic use: two involved short-term use of low daily doses prior to pregnancy (51.1%), while three involved long-term use of low (20.9%), moderate (11.0%) and high (2.0%) daily doses throughout pregnancy. One trajectory (15.0%) involved increasing use during pregnancy. Women with long-term use were more likely to have a schizophrenia or bipolar disorder diagnosis, to have used multiple psychotropics and to have a mental health hospitalisation during pregnancy. Overall, women using antipsychotics had elevated rates of adverse birth outcomes compared to unexposed women. Women with the greatest antipsychotic exposure had the highest rates of gestational diabetes and gestational hypertension. Conclusion: Women using antipsychotics around pregnancy are heterogeneous, with varying patterns of use and associated birth outcomes, reflecting underlying differences in the indications for treatment and/or severity of illness. This diversity should be considered when developing clinical guidelines and designing safety studies.

Longitudinal Methods for Modeling Exposures in Pharmacoepidemiologic Studies in Pregnancy

“…GBTM identified 4 distinct patterns of use ( Figure 2B ), with lower education of the mother predicting membership in the lowest thyroid hormone replacement therapy use group. Other studies using GBTM grouped women according to the probability of filling an opioid prescription in each of 12 months after cesarean delivery ( 29 ) and antipsychotic use ( 30 ). In the latter study, women with the greatest exposure to antipsychotics had the highest rates of gestational hypertension and gestational diabetes.…”

Trajectories of pregabalin use and their association with longitudinal changes in opioid and benzodiazepine use

“…We used group-based trajectory modelling to classify people based on similar patterns of pregabalin use over time using a censored normal distribution. 33,42 We chose the most appropriate number of trajectories based on a combination of statistical criteria and clinical relevance in discussion with clinical coauthors (N.A.B. and J.B.), as relying solely on statistical criteria can result in a model with a large number of trajectories that are difficult to interpret and not clinically meaningful.…”

Trajectories of ADHD medication use before, during, and after pregnancy: A population‐based study from Norway and Sweden

“…Additionally, ADHD medication use can be impacted by maternal characteristics, pregnancy history, and use of other psychotropic medication. Therefore, novel clustering methods such as group‐based trajectory modeling (GBTM) can be used to capture complex medication use patterns 13–16 . Elucidating these patterns can guide future research on ADHD medication safety and efficacy for women in their reproductive years.…”