Antipsychotics Safe for Pregnant Women

The results of the largest study of its kind to date indicate that new antipsychotic medications-including quetiapine, olanzapine, and risperidone-do not appear to put women at additional risk of developing gestational diabetes, hypertensive disorders, or major blood clots that obstruct circulation, all conditions that often develop during pregnancy or with the use of older antipsychotic medications.

The results of the largest study of its kind to date indicate that new antipsychotic medications—including quetiapine, olanzapine, and risperidone—do not appear to put women at additional risk of developing gestational diabetes, hypertensive disorders, or major blood clots that obstruct circulation, all conditions that often develop during pregnancy or with the use of older antipsychotic medications. The study, led by researchers at Women’s College Hospital and the Institute for Clinical Evaluative Sciences, was published in the May 13, 2015 issue of BMJ.

“Antipsychotic drug use during pregnancy is on the rise, but little is known about possible effects of the newer medications on maternal health or perinatal outcomes like pre-term birth or large birth weight,” said Simone Vigod, MD, MSc, FRCPC, Scientist, Women’s College Research Institute; Staff Psychiatrist, Women’s College Hospital; and Assistant Professor, Department of Psychiatry, University of Toronto. That’s why Vigod and colleagues sought to evaluate maternal and perinatal outcomes associated with antipsychotic drug use in pregnancy.

For the study, Vigod and colleagues compared 1,021 women who delivered a singleton infant between 2003 and 2012 who had at least two consecutive prescriptions for an antipsychotic medication during pregnancy and at least one of which that had been filled in the first or second trimester with 1,021 pregnant women of similar age, income, mental health status, and healthcare utilization who did not take antipsychotics. The main maternal medical outcomes were gestational diabetes, hypertensive disorders or pregnancy, and venous thromboembolism, whereas the main perinatal outcomes were preterm birth (before 37 weeks) and birth weight in the less than third or greater than 87th centile.

No significant differences were observed in risk for gestational diabetes, gestational hypertensive disorders, or venous thromboembolism between prescribed antipsychotics during pregnancy and those who did not take antipsychotics during pregnancy. No significant differences were observed in risk of preterm delivery, extremely low birth weights, or extremely high birth rates between infants born to women who took antipsychotics during pregnancy and those born to women who did not. However, women who used antipsychotics during pregnancy were more likely to require labor induction when compared with those who did not take these drugs.

“The maternal and perinatal medical risks associated with antipsychotic drug use itself during pregnancy appear to be minimal,” said Vigod. “Ultimately, our results support better-informed decision making for women managing mental illness… Our results are reassuring for women who require antipsychotic medication to maintain their mental health stability during pregnancy, at least with respect to short term maternal and infant outcomes. Research into longer term child outcomes will be needed to provide a full picture of the long term impact of antipsychotic exposure in a developing fetus.”