ABSTRACT
Between 0.3%–4.6% of women use antipsychotic (AP) drugs during pregnancy. Two large, retrospective, population-based cohort studies, conducted in Nordic countries and in the US, examined the risk of neurodevelopmental disorders (NDDs) following gestational exposure to APs. The Nordic study found that, in unadjusted analyses, exposure to APs during pregnancy was associated with increased risk of attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) in offspring; that the risk all but disappeared after adjusting for covariates; and that the risk appeared to be related to maternal major mental illness rather than to gestational exposure to APs. The US study also found that, in unadjusted analyses, gestational exposure to APs was associated with an increased risk of almost all of the study-specified NDDs in offspring; however, after adjusting for covariates, the risks were no longer meaningfully increased and, importantly, were no longer statistically significant for ADHD and ASD. Thus, these 2 studies suggest that gestational exposure to APs is a marker of NDD risk in offspring rather than a potential cause. Whereas a small but significantly increased risk was identified for aripiprazole in the US study, the signal was inconsistent across analyses, and confounding due to maternal mental illness was not ruled out. Previous studies have suggested that the use of APs during pregnancy is not associated with an increased risk of major congenital malformations and other adverse gestational outcomes. Considering the potential harm and suffering associated with major mental illness and the very low risks associated with AP use during pregnancy, initiation or continuation of APs appears to carry a favorable risk-benefit ratio in pregnant women who need these drugs; however, decision-making should be shared between patients, their caregivers, and the treating team.
Continue Reading...
Did you know members enjoy unlimited free PDF downloads as part of their subscription? Subscribe today for instant access to this article and our entire library in your preferred format. Alternatively, you can purchase the PDF of this article individually.
References (13)
- Reutfors J, Cesta CE, Cohen JM, et al. Antipsychotic drug use in pregnancy: a multinational study from ten countries. Schizophr Res. 2020;220:106–115. PubMed CrossRef
- Andrade C. Major congenital malformations associated with exposure to second-generation antipsychotic drugs during pregnancy. J Clin Psychiatry. 2021;82(5):82. PubMed CrossRef
- Andrade C. Gestational and neurodevelopmental outcomes associated with antipsychotic drug exposure during pregnancy. J Clin Psychiatry. 2021;82(5):21f14265. PubMed CrossRef
- Hálfdánarson Ó, Cohen JM, Karlstad Ø, et al. Antipsychotic use in pregnancy and risk of attention/deficit-hyperactivity disorder and autism spectrum disorder: a Nordic cohort study. Evid Based Ment Health. 2022;25(2):54–62. PubMed
- Straub L, Hernández-Díaz S, Bateman BT, et al. Association of antipsychotic drug exposure in pregnancy with risk of neurodevelopmental disorders: a national birth cohort study. JAMA Intern Med. 2022;182(5):522–533. PubMed CrossRef
- Mendhekar DN, Sunder KR, Andrade C. Aripiprazole use in a pregnant schizoaffective woman. Bipolar Disord. 2006;8(3):299–300. PubMed CrossRef
- Yskes R, Thomas R, Nagalla M-L. A case of decreased milk production associated with aripiprazole. Prim Care Companion CNS Disord. 2018;20(6):18l02303. PubMed CrossRef
- Komaroff A. Aripiprazole and lactation failure: The importance of shared decision making. a case report. Case Rep Womens Health. 2021;30:e00308. PubMed CrossRef
- Cross-Disorder Group of the Psychiatric Genomics Consortium. Genomic relationships, novel loci, and pleiotropic mechanisms across eight psychiatric disorders. Cell. 2019;179(7):1469–1482.e11. PubMed CrossRef
- Wang Z, Chan AYL, Coghill D, et al. Association between prenatal exposure to antipsychotics and attention-deficit/hyperactivity disorder, autism spectrum disorder, preterm birth, and small for gestational age. JAMA Intern Med. 2021;181(10):1332–1340. PubMed CrossRef
- Beex-Oosterhuis MM, Van Gool AR, Heerdink ER, et al. Clozapine treatment during pregnancy and the postpartum period: a systematic literature review. J Clin Psychiatry. 2021;83(1):21r13952. PubMed CrossRef
- Reinstein SA, Cosgrove J, Malekshahi T, et al. Long-acting injectable antipsychotic use during pregnancy: a brief review and concise guide for clinicians. J Clin Psychiatry. 2020;81(6):20ac13597. PubMed CrossRef
- Tosato S, Albert U, Tomassi S, et al. A systematized review of atypical antipsychotics in pregnant women: balancing between risks of untreated illness and risks of drug-related adverse effects. J Clin Psychiatry. 2017;78(5):e477–e489. PubMed CrossRef
Advertisement
GAM ID: sidebar-top
