Aussie researchers have made significant findings in neurodevelopmental and intellectual outcomes from maternal exposure.
Taking antipsychotics during pregnancy does not lead to an increased risk of neurodevelopmental disorders in children, a UNSW study has shown.
Researchers found little to no increased risk of intellectual disability, learning, speech or language disorders associated with maternal antipsychotic use, as well as no significant differences in school performance in maths and language.
Using long-term international data of over 200,000 children over a 20-year period, the study authors say this research is the most comprehensive study to date on maternal antipsychotics and neurodevelopmental outcomes All mothers of these children had been diagnosed with a psychiatric condition, and roughly 5% had taken antipsychotics when pregnant.
Denmark, Finland, Iceland, Norway, and Sweden all have similar health and education systems, so researchers were able to compare birth outcomes as well as results of early childhood standardised testing (similar to NAPLAN).
Academic test scores did not vary between children who had been exposed to antipsychotic medications in utero and those who had not.
The cumulative incidence of neurodevelopmental disorders in the exposed group was found to be 4.0%, while in the unexposed group, it was 2.2%.
However, after adjusting for cofounders, the researchers found that the association between prenatal exposure and neurodevelopmental disorder was weaker than that and concluded that there was no significant increase in overall risk observed.
“We already know these women are dealing with psychiatric conditions, and by genetic default, their children would be more likely to have psychiatric or neurodevelopmental outcomes,” said Associate Professor Helga Zoega, senior author of the study and UNSW pharmacoepidemiologist.
The study also found that women who used antipsychotics during pregnancy were more likely to be aged 35 years or older, use other medications during pregnancy, smoke, have a lower education level and a higher BMI than women who did not take antipsychotics during pregnancy. All of these are cofounding factors which may impact birth outcomes and neurodevelopment.
“We’re focused on the risks and benefits of the medication treatment in pregnancy, so we use methods to make the comparison groups as similar as possible,” she said.
Quetiapine, olanzapine, prochlorperazine, perphenazine, aripiprazole and levomepromazine were the most common antipsychotic medications in the study.
Chlorpromazine was the only exception to the findings, with the study showing an association between prenatal exposure and speech and language disorders in offspring. However, the authors noted that these findings were limited by small sample size.
The use of chlorpromazine in pregnancy is diminishing across several countries, they said. Few women in the study used it and it is no longer on the Nordic market.
“Regardless, where possible patients and clinicians may choose alternative antipsychotics to chlorpromazine,” they said.
Antipsychotics in Australia tend to be either category C or category B3 as some animal studies have suggested adverse outcomes.
Prenatal exposure to antipsychotics such as haloperidol, risperidone, quetiapine, and olanzapine has led to neurotoxicity in some animal studies, which can cause learning and memory issues.
Associate Professor Zoega described the findings of this study as reassuring.
“This is essential information for the management of serious mental health conditions in pregnancy,” she said.
eClinical Medicine (part of The Lancet Discovery Science) 2024, onling 17 March
