Researchers Analyze Safety of Antipsychotics During Pregnancy
According to a population-based cohort study published in the BMJ on May 13, women taking the antipsychotics quetiapine (Seroquel), olanzapine (Zyprexa), or risperidone (Risperdal) during pregnancy did not have higher rates of complications such as gestational diabetes, preterm birth, or infants with extremely high or low birth weight.
Details of the Antipsychotics Study
Zachary Stowe, MD, from the Departments of Psychiatry, Pediatrics, and Obstetrics and Gynecology at the University of Arkansas made this statement, though not involved in the study: “If a practicing clinician encounters an individual currently taking an atypical antipsychotic, who finds out that she is pregnant, [this study suggests] that you would not need to reflexively stop or change their medicine.”
The “atypical” antipsychotic medications studied are more common than first-generation antipsychotics now. This study showed zero increase in conditions, such as a higher risk for metabolic syndrome and venous thromboembolism, among pregnant women taking atypical antipsychotics compared with among pregnant women not taking those drugs, even though the newer drugs are considered to have those potential risks.
Researchers involved in this study evaluated Canadian women who had access to hospital care and drug coverage and gave birth to a baby between April 2003 and December 2012. Of the 52,615 eligible women, 1,323 were considered to be taking antipsychotics and 1,021 could be matched, using a high dimensional propensity score, with women who did not take any antipsychotics in pregnancy.
Findings of the Antipsychotics Study
Users of antipsychotic had higher rates of hypertensive disorders and blood clots than the general population, but their rates weren't any higher than the matched cohort. Among the matched groups, women taking atypical antipsychotics didn't have significantly greater risks for complications, including gestational diabetes, preterm birth, hypertensive disorders including preeclampsia, venous thromboembolism, or infants with birth weights below the third or above the 97th percentile.
Women taking antipsychotics showed to have higher rates of labor induction and operative vaginal delivery. However, women taking antipsychotics in the unmatched cohort were at higher risk for several complications, including preterm birth before 32 weeks.
Simone N. VIgod, MD, from the Department of Psychiatry at the Women's College Research Institute and the Women's College Hospital at the University of Toronto, Ontario, Canada, and colleagues, wrote, “Our findings suggest that antipsychotic medication use in pregnancy poses a minimal risk for adverse outcomes for the pregnant woman and her fetus.”
Researchers noted that because complication rates were higher in the matched cohort than in the unmatched group or in the general population, women taking antipsychotics may be in a population that is already at greater risk for these complications. It is also possible that previous antipsychotic use may have influenced metabolic function before pregnancy.
Dr. Stowe told Medscape Medical News, “the study design looks like it's been done very well. We always have to interpret results like this fairly cautiously, but the bulk of their findings are consistent with my own clinical experience and the previous reports on this class of medicines from much smaller studies, which has not really indicated any acute assignable risk to this class of medicines
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