Pregnant women who need antipsychotic medication often face a difficult dilemma: Go off the drugs and risk a relapse, or continue the medication during pregnancy and risk potential health complications.
New findings published in the BMJ on Wednesday may make that decision a little easier. The study, conducted at the Institute for Clinical Evaluative Sciences in Toronto, has found newer antipsychotic medications do not put pregnant women and their babies at greater risk for a number of major health concerns, including gestational diabetes, hypertensive (high blood pressure) disorders, blood clots and preterm birth.
The study is believed to be the largest to date to look at how pregnancy is impacted by second generation antispychotic drugs (also known as "atypical" drugs), such as quetiapine, olanzapine and risperidone.
"These results are pretty reassuring both for the health of the mother in pregnancy to continue her medication, and also, at least for the short-term, for the health of the baby," says Simone Vigod, author of the study and a psychiatrist and scientist at Women's College Hospital in Toronto.
The use of antipsychotic drugs during pregnancy has increased considerably over the years, as more women with serious psychiatric conditions, such as schizophrenia and bipolar disorder, go on to have successful pregnancies, Dr. Vigod says. Plus, the growing use of this newer class of antipsychotics to treat other conditions, such as depression, also means there are more women considering or facing pregnancy while taking the medications. However, the impact of these drugs on maternal and infant health has not been well studied.
Discontinuing the drugs during pregnancy can have serious consequences, Dr. Vigod explains. Women who stop their medication have a much higher risk of relapse of their psychiatric conditions, which could negatively affect their ability to take care of themselves and the developing fetus.
"It may, in more extreme cases, even put her in a position where she won't be able to parent that child that she might have very much wanted," Dr. Vigod adds.
In their matched cohort study, the researchers compared 1,021 women who were taking antipsychotics during pregnancy against 1,021 women with similar baseline measures, including age, mental health and medical characteristics, who did not take antipsychotic medication.
Because atypical antipsychotics are believed to potentially cause weight gain and increase the risk of diabetes and high blood pressure in non-pregnant individuals, the researchers zeroed in on their effect on gestational diabetes, blood clots and pre-eclampsia, a high blood pressure problem in pregnancy. They also examined whether women on antipsychotics were more likely to give birth to premature babies or babies with exceptionally high or exceptionally low birth weights, as well as whether the babies were at higher risk of withdrawal symptoms.
The researchers concluded that women on the drugs and their babies may be at higher risk than the general population for some of these health conditions. However, when compared against others who had similar baseline profiles, their outcomes were the same. That means antipsychotic drugs are likely not the cause of the heightened risks.
"We shouldn't come out of this saying everyone who takes antipsychotic medications is going to have a healthy baby," Dr. Vigod says. But the increased risks they face are "probably due to some other health or health-related factor."
Reproductive toxicologist Irena Nulman, a professor of pediatrics at the University of Toronto who was not involved in the study, says individuals are rarely taking antipsychotics alone, but with other drugs, such as sedatives or hypnotic drugs or antidepressants.
Decisions about whether to stay on or discontinue medication during pregnancy should be based on the severity of the disorder, weighing the benefits of treatment against the potential risk, she says. "Most important is to prevent the severe postpartum complications in mental health."