Gestational and Neurodevelopmental Outcomes Associated With Antipsychotic Drug Exposure During Pregnancy.

Exposure to psychotropic drugs during pregnancy may adversely affect gestational and neurodevelopmental outcomes in many different ways. Much literature on the subject exists for antidepressant drug exposure. In contrast, the literature on antipsychotic drug exposure during pregnancy is relatively thin; this is a situation in which the underlying psychiatric disorder, the context of use, and the associated risks must all be understood. In this context, a large (n = 411,251 mother-child pairs), population-based, retrospective observational cohort study with 8-10 years of follow-up examined pregnancy (preterm birth, small for gestational age) and neurodevelopmental (attention-deficit/hyperactivity disorder [ADHD], autism spectrum disorder [ASD]) outcomes after gestational exposure to antipsychotic medications. The study found that, when exposed vs unexposed pregnancies were compared, gestational exposure to antipsychotics was associated with a small but significantly increased risk of preterm birth; there was no significant increase in the risk of small for gestational age, ADHD, or ASD. When pregnancies with gestational vs (only) pregestational (pre-pregnancy) exposure to antipsychotics were compared, and when exposed vs unexposed siblings were compared, gestational antipsychotic exposure was not associated with a significantly increased risk of any of these adverse outcomes. Pregnancies with only pregestational exposure were associated with all of the adverse outcomes (except ASD) relative to pregnancies in women with no antipsychotic exposure at any time. In antipsychotic-unexposed pregnancies, mothers with psychiatric disorders were more likely to have children with ADHD or ASD (but not preterm birth or small for gestational age) relative to mothers without psychiatric disorders. The findings of the study appear reassuring. However, there are many concerns about the study, some of which are potentially serious. The findings of the study should therefore be interpreted with caution, and decisions about antipsychotic use during pregnancy should continue to be made on a case-by-case basis, in consultation with the patient and her family. In most cases of women with major mental illness, the risk-benefit ratio is likely to favor continuation of antipsychotics during pregnancy.