Antipsychotic Use in Early Pregnancy and the Risk of Maternal and Neonatal Complications |
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| Institution: | 1. School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei City, Taiwan;2. Department of Obstetrics and Gynecology, Taipei Medical University, Taipei City, Taiwan;3. Graduate Institute of Clinical Pharmacy and School of Pharmacy, College of Medicine, National Taiwan University;4. Department of Pharmacy, National Taiwan University Hospital;5. Departments of Population Health and Radiation Oncology, University of Kansas School of Medicine, Kansas City, KS, USA;6. Department of Radiation Oncology, University of Kansas School of Medicine, Kansas City, KS, USA;7. Department of Obstetrics and Gynecology, Taipei Medical University Hospital;1. Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Spain;2. Centro de Investigación Biomédica en Red of Epidemiology and Public Health, Madrid, Spain;3. National Center for Epidemiology, Carlos III Health Institute, Madrid, Spain;4. IMDEA-Food Institute, CEI UAM+CSIC, Madrid, Spain;5. Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA;1. Transplantation Division, Department of Surgery, University of Minnesota, Minneapolis;2. Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN;1. Novartis Institutes of Biomedical Research, Cambridge, MA;2. Department of Hematology, Mayo Clinic, Rochester, MN;1. Hospital of the University of Pennsylvania, Department of Pathology and Laboratory Medicine, Anatomic Pathology & Neuropathology Residency Program, Perelman School of Medicine at the University of Pennsylvania, Philadelphia;2. Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia;1. Department of Molecular Pharmacology & Experimental Therapeutics, Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, MN, USA;2. Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology, Mayo Clinic, Rochester, MN, USA;3. Department of Cardiovascular Medicine, Division of Heart Rhythm Services, Windland Smith Rice Genetic Heart Rhythm Clinic, Mayo Clinic, Rochester, MN, USA |
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| Abstract: | ObjectiveTo assess the association between antipsychotic use in early pregnancy and the risk of maternal and neonatal metabolic complications.MethodsWe conducted a population-based retrospective cohort study (January 1, 2010, to December 31, 2016) using the Health and Welfare Database in Taiwan. Pregnant women (18 to 49 years of age) were grouped as antipsychotic users (ie, received oral antipsychotic monotherapy during the first 20 weeks of pregnancy) and nonusers. Antipsychotic users were further categorized into first-generation antipsychotic and second-generation antipsychotic users. Propensity score methods, including matching and inverse probability of treatment weighting, were used to balance covariates. Conditional logistic regression and Cox proportional hazards models were used to compare risks of maternal (gestational diabetes mellitus, preterm birth) and neonatal (low birth weight LBW], macrosomia) outcomes.ResultsAntipsychotic users had a notably higher risk of preterm birth compared with nonusers (adjusted HR, 1.29; 95% CI, 1.04 to 1.60), but the risk of gestational diabetes mellitus (HR, 1.21; 95% CI, 0.94 to 1.56), LBW (odds ratio OR], 1.07; 95% CI, 0.84 to 1.37), and macrosomia (OR, 1.36; 95% CI, 0.63 to 2.92) did not differ between the two groups. Among women who received antipsychotics, the odds of LBW were significantly higher in second-generation antipsychotic users compared with first-generation antipsychotic users (adjusted OR, 1.32; 95% CI, 1.04 to 1.68).ConclusionThis study found that using antipsychotics in early pregnancy did not result in a greater risk of metabolic complications both for mothers and newborns. For women requiring treatment with antipsychotics during pregnancy, they should be monitored for the risk of preterm birth and low infant birth weight. |
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