No Worse Outcomes for Children Exposed to Prenatal Antipsychotics

Researchers from the UCL School of Pharmacy studied an electronic health record database to examine the link between prenatal antipsychotic exposure and risk for birth and neurodevelopmental problems, including attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), preterm birth and small for gestational age. The study included more than 300,000 mother-child pairs for ADHD and 400,000 pairs for ASD, preterm birth, and small for gestational age analyses.

Children of mothers who were taking antipsychotics during pregnancy showed no increased risk for developing ADHD, ASD, or being born small for gestational age. Primary results found a 40% higher risk for preterm birth when compared with gestationally non-exposed individuals, but further analyses did not support the finding. In examining gestationally exposed children with those whose mother had past exposure only (use before pregnancy), there was no increased risk for any of the outcomes.

When comparing the antipsychotic exposure among siblings, there still were not any significant risk differences seen in regards to any of the outcomes assessed. The findings also highlight that pregnant patients with mental health conditions, whether or not they are prescribed medication, are at high risk of ADHD and ASD. Given the benefits of treating psychosis during pregnancy, the study results do not support a recommendation for women to discontinue their regular antipsychotic treatment during pregnancy.

There are not a lot of psychiatrists with expertise in managing medications in pregnancy, so most pregnant women with psychiatric disorders are managed by general psychiatrists or obstetricians and there is always a dilemma on whether to treat or not to treat patients who are pregnant. These findings should provide some reassurance to patients and clinicians who are fearful of antipsychotic medications causing harm to the future child. The illnesses that antipsychotic medications are used to treat, including bipolar disorder and schizophrenia, are highly morbid, and these data support the importance of continuing treatment.

This is a research output of the C W Maplethorpe Fellowship.

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Further information:

Ms Zixuan Wang (Twitter: @ZixuanWang_ZW)
Dr Kenneth Man (Twitter: @KennethKCMan)
Professor Ian Wong (Twitter: @Ian_HKU)