Pregnancy outcomes following maternal exposure to second generation antipsychotics: considering polytherapy

Abstract

Studies on the reproductive safety of second generation antipsychotics (SGAPs) are scarce, and none have compared monotherapy to polytherapy. A cohort study using a prospectively collected database was conducted. Pregnancy outcomes of 133 women exposed to SGAPs and other psychotropic drugs and 133 matched healthy controls were assessed. Psychotropic drug polytherapy was documented in 72% of exposed women. The exposed women had significantly higher pre‐pregnancy weight, smoked more cigarettes, experienced more associated comorbidities and instrumental deliveries and delivered more large for gestational age children. More of the exposed neonates were born premature, admitted to the intensive care unit and presented with poor neonatal adaptation signs and higher major malformations rates. In the monotherapy subgroup, no malformations were reported. In utero exposure to antipsychotic polytherapy is associated with adverse pregnancy outcomes for both mother and child. SGAP monotherapy appears to be associated with less risk to the fetus. Future studies should differentiate among the effects of psychotropic medication exposure and the underlying psychopathology and associated comorbidities.