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Maternal use of antipsychotics 'raises prevalence of adverse outcomes’

Researchers have shown an association between maternal use of second-generation atypical antipsychotics and adverse pregnancy outcomes for the first time.

The study

The study analysed 133 pregnant women exposed to second-generation atypical antipsychotics (SGAs) and other psychotropic drugs and matched them with the same number of healthy controls. They were followed up by telephone interviews from 2009 to 2012 to record maternal medical and obstetric histories and the type and duration of SGAs and other psychotropic medications used in pregnancy. Their children’s data were obtained from the child’s physician separately.

The findings

In the exposed group, the most common SGAs were quetiapine, olanzapine or risperidone. Neonates in the exposed group were about two and a half times more likely to be premature (<37 weeks gestation), compared with controls (10.6% versus 4.3%)and had a two and a half times higher incidence of malformations, compared with controls (6.2% versus 2.6%). The prevalence rate of neonatal intensive care unit (NICU) admissions was 25% in the exposed group of 91 neonates vs controls (116 total controls). A high proportion of neonates (82.6%) who were admitted to NICU were exposed to polytherapy, the majority to SSRIs.

What it means for GPs

This study is the first to show a significant association between maternal SGA use in pregnancy and an elevated risk of NICU admission, said the authors. They added: ‘Indications for polytherapy in pregnant women should be seriously considered and made on an individual basis following a thorough risk/benefit analysis.’

BMJ Open 2013, online 13 July

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