Risk for Gestational Diabetes Linked to Antipsychotic Use During Pregnancy

Women who have been exposed to antipsychotic agents during pregnancy have an increased risk for gestational diabetes mellitus (GDM) and thus may benefit from close pregnancy monitoring, early GDM testing, and lifestyle modification. A systematic review and meta-analysis were conducted to evaluate GDM risk associated with antipsychotic exposure during pregnancy. Results of the study were published in the journal Schizophrenia Bulletin.

The investigators performed a systematic literature search using PubMed, Science Direct, Scopus, and Web of Science databases through August 22, 2018. In their meta-analysis, they included randomized controlled trials, case-control studies, and cohort studies that reported on GDM risk among women exposed to antipsychotic medications, women who had stopped taking antipsychotic medications, and healthy controls. The primary outcomes included study-defined GDM, which accounted for the number of events, odds ratios, and/or risk ratios (RRs) with 95% CIs.

A total of 10 studies were included in the meta-analysis. There were 6213 participants in the group of women exposed to antipsychotic medications, 6836 participants in the group who had stopped taking antipsychotic medications, and 1,677,087 participants in the healthy control arm. The unadjusted cumulative RR for GDM associated with the use of antipsychotic agents, compared with the healthy controls, was 1.63 (95% CI, 1.20-2.22). The adjusted risk for GDM was significantly higher among those exposed to antipsychotic medications compared with the healthy controls (RR, 1.30; 95% CI, 1.023-1.660; P = .32). In contrast, the adjusted risk for GDM was similar between those exposed to antipsychotic medications and those who had ceased taking antipsychotic medication (RR, 0.78; 95% CI, 0.281-2.164).

Based on the findings of this analysis, no significant association was observed among quality of the study, alcohol use, smoking, cumulative risk for GDM, and gestational age.

The investigators concluded that because GDM can lead to adverse events in both the mother and the offspring, antipsychotic medications should not be used without an appropriate indication. Even though the termination of these agents during pregnancy may reduce the mother’s risk for GDM, tapering can lead to an increased risk for exacerbations in psychiatric symptoms. Clinicians need to carefully assess the risks and benefits of antipsychotic medications during pregnancy and should engage in shared decision making with patients. Furthermore, testing for GDM during the first trimester, rather than between 24 and 28 gestational weeks, may help to prevent the development of GDM among patients with serious mental illness.

Reference
Kucukgoncu S, Guloksuz S, Celik K, et al. Antipsychotic exposure in pregnancy and the risk of gestational diabetes: a systematic review and meta-analysis [published online June 5, 2019]. Schizophr Bull. doi:10.1093/schbul/sbz058