Second-generation antipsychotics and pregnancy complications

Abstract

Purpose To study if second-generation antipsychotic (S-GA) use during pregnancy is associated with an increased risk of pregnancy and neonatal complications. Methods A population-based birth cohort study using national register data extracted from the "Drugs and Pregnancy" database in Finland, years 1996-2016. The sampling frame included 1,181,090 pregnant women and their singleton births. Women were categorized into three groups: exposed to S-GAs during pregnancy (n = 4225), exposed to first-generation antipsychotics (F-GAs) during pregnancy (n = 1576), and unexposed (no purchases of S-GAs or F-GAs during pregnancy, n = 21,125). Pregnancy outcomes in S-GA users were compared with those in the two comparison groups using multiple logistic regression models. Results Comparing S-GA users with unexposed ones, the risk was increased for gestational diabetes (adjusted odds ratio, OR 1.43; 95% CI 1.25-1.65), cesarean section (OR 1.35; 95% CI 1.18-1.53), being born large for gestational age (LGA) (OR 1.57; 95% CI 1.14-2.16), and preterm birth (OR 1.29; 95% CI 1.03-1.62). The risk for these outcomes increased further with continuous S-GA use. Infants in the S-GA group were also more likely to suffer from neonatal complications. Comparing S-GA users with the F-GA group, the risk of cesarean section and LGAwas higher (OR 1.25, 95% CI 1.03-1.51; and OR 1.89, 95% CI 1.20-2.99, respectively). Neonatal complications did not differ between the S-GA and F-GA groups. Conclusions Prenatal exposure to S-GAs is associated with an increased risk of pregnancy complications related to impaired glucose metabolism. Neonatal problems are common and occur similarly in S-GA and F-GA users.

Women with Schizophrenia over the Life Span: Health Promotion, Treatment and Outcomes

“…Infants in the drug group were also more likely than controls to suffer from neonatal complications. The number and severity of neonatal complications did not differ between first and second generation antipsychotic users [60].…”

“…Ellfolk and collaborators [60] included 1,181,090 pregnant women and their singleton births in a population-based birth cohort study using national register data extracted from the Drugs and Pregnancy database in Finland. Pregnant users of second generation antipsychotics were shown to have an increased risk for GDM, for cesarean section, for infants born large for gestational age and for preterm birth.…”

Second-generation antipsychotic use during pregnancy and risk of congenital malformations

“…Of the individual S-GAs, olanzapine use was associated with a twofold increased risk of overall malformations, and specifically, a nearly fourfold increased risk of musculoskeletal malformations when compared to unexposed. Use of S-GAs has been increasing among the pregnant population [3,4] and indications for S-GA use have expanded during the last decade to include also illnesses outside psychotic disorders [3,5]. S-GAs are used increasingly in treating bipolar disorder and as augmentation treatment in unipolar depression [15].…”

“…More detailed information on the registers included have been published previously [ 4 ] and are also available in the Supplementary material .…”

“…The use of S-GA has been steadily increasing among pregnant women since year 2000; a recent study from ten countries reported that up to 2% of pregnant women use S-GAs, while there are differences across countries [ 3 ]. At the same time, the use of first generation antipsychotics (F-GA) has waned [ 3 , 4 ]. The increasing use of S-GAs may be at least partly explained by the increasing off-label use of quetiapine for insomnia [ 2 , 5 ].…”