Antipsychotic drug use in pregnancy

An analysis of the risks and safety of using second-generation antipsychotic medications during pregnancy.

There has been a considerable rise in antipsychotic medication use in pregnancy, from 3 per 1000 pregnancies in 2001 to 8 per 1000 in 2007. Case reports, case series, voluntary registries, and small cohort studies suggest that antipsychotic drug exposure in pregnancy is unlikely to cause congenital anomalies but may be associated with preterm birth, low birth weight for gestational age, and neonatal withdrawal effects. However, most data were based on the older, “typical” antipsychotic drugs, which are now less commonly used. Second generation antipsychotic drugs were first introduced in the early 1990s and differ from earlier agents in terms of their side effects, especially their potentially higher risk of metabolic syndrome and venous thromboembolism. The few studies that have evaluated atypical antipsychotic drugs in pregnancy were limited in sample size, and in the handling of confounding by indication. Accordingly, these studies may not have been equipped to evaluate the impact of antipsychotic drug use in pregnancy on important maternal medical and perinatal conditions. In this study, the researchers evaluated maternal medical and perinatal outcomes associated with antipsychotic drug use in pregnancy in multiple linked population health administrative databases in the entire province of Ontario, Canada. Read the full research: bmj.com/content/350/bmj.h2298