Department of Clinical Psychopharmacology and Neurotoxicology, National Institute of Mental Health and Neurosciences, Bangalore, India (
J Clin Psychiatry. 2022 May 30;83(3):22f14529. doi: 10.4088/JCP.22f14529.
Between 0.3%-4.6% of women use antipsychotic (AP) drugs during pregnancy. Two large, retrospective, population-based cohort studies, conducted in Nordic countries and in the US, examined the risk of neurodevelopmental disorders (NDDs) following gestational exposure to APs. The Nordic study found that, in unadjusted analyses, exposure to APs during pregnancy was associated with increased risk of attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) in offspring; that the risk all but disappeared after adjusting for covariates; and that the risk appeared to be related to maternal major mental illness rather than to gestational exposure to APs. The US study also found that, in unadjusted analyses, gestational exposure to APs was associated with an increased risk of almost all of the study-specified NDDs in offspring; however, after adjusting for covariates, the risks were no longer meaningfully increased and, importantly, were no longer statistically significant for ADHD and ASD. Thus, these 2 studies suggest that gestational exposure to APs is a marker of NDD risk in offspring rather than a potential cause. Whereas a small but significantly increased risk was identified for aripiprazole in the US study, the signal was inconsistent across analyses, and confounding due to maternal mental illness was not ruled out. Previous studies have suggested that the use of APs during pregnancy is not associated with an increased risk of major congenital malformations and other adverse gestational outcomes. Considering the potential harm and suffering associated with major mental illness and the very low risks associated with AP use during pregnancy, initiation or continuation of APs appears to carry a favorable risk-benefit ratio in pregnant women who need these drugs; however, decision-making should be shared between patients, their caregivers, and the treating team.
有 0.3%-4.6%的女性在怀孕期间使用抗精神病药物（AP）。两项在北欧国家和美国进行的大型回顾性基于人群的队列研究，考察了妊娠期接触 AP 后发生神经发育障碍（NDD）的风险。北欧的研究发现，在未调整的分析中，怀孕期间接触 AP 与后代患注意缺陷多动障碍（ADHD）和自闭症谱系障碍（ASD）的风险增加有关；调整协变量后，这种风险几乎消失；而且这种风险似乎与母亲的主要精神疾病有关，而不是与妊娠期接触 AP 有关。美国的研究还发现，在未调整的分析中，妊娠期接触 AP 与后代几乎所有研究指定的 NDD 风险增加有关；然而，在调整协变量后，风险不再显著增加，重要的是，ADHD 和 ASD 的风险不再具有统计学意义。因此，这两项研究表明，妊娠期接触 AP 是后代 NDD 风险的一个标志物，而不是潜在的原因。尽管美国的研究发现阿立哌唑的风险略有增加，但信号在分析中不一致，并且不能排除因母亲精神疾病而导致的混杂。先前的研究表明，怀孕期间使用 AP 与主要先天性畸形和其他不良妊娠结局的风险增加无关。考虑到与主要精神疾病相关的潜在伤害和痛苦，以及与怀孕期间使用 AP 相关的非常低的风险，对于需要这些药物的孕妇，启动或继续使用 AP 似乎具有有利的风险效益比；然而，决策应该在患者、他们的照顾者和治疗团队之间共享。
