title: Antipsychotics during pregnancy: relation to fetal and maternal metabolic effects.
abstract: BACKGROUND
  Knowledge about the effects of exposure to the newer antipsychotics during pregnancy is limited.
  
  
  OBJECTIVE
  To investigate the effects of maternal use of antipsychotics during pregnancy on gestational diabetes and fetal growth.
  
  
  METHODS
  Population-based cohort study comparing women exposed and not exposed to antipsychotics during pregnancy. Exposure was defined as prescriptions filled.
  
  
  METHODS
  Swedish national health registers.
  
  
  METHODS
  All women giving birth in Sweden from July 1, 2005, through December 31, 2009, grouped by filled prescriptions for (1) olanzapine and/or clozapine, the most obesogenic and diabetogenic antipsychotics (n = 169), (2) other antipsychotics (n = 338), or (3) no antipsychotics (n = 357,696).
  
  
  METHODS
  Odds ratios (ORs) with 95% CIs for gestational diabetes and being small for gestational age (SGA) and large for gestational age for birth weight, birth length, and head circumference.
  
  
  RESULTS
  Exposure to other antipsychotics was associated with an increased risk of gestational diabetes (adjusted OR, 1.77 [95% CI, 1.04-3.03]). The risk increase with olanzapine and/or clozapine was of similar magnitude but not statistical significance (adjusted OR, 1.94 [95% CI, 0.97-3.91]). Infants exposed to either group of antipsychotics had increased risks of being SGA on birth weight, whereas only exposure to other antipsychotics yielded increased risks of being SGA for birth length and head circumference. None of the risks for SGA measurements remained significant after adjusting for maternal factors. There were no increased risks of being large for gestational age for birth weight or birth length after exposure to olanzapine and/or clozapine, but the risk increased for head circumference (OR, 3.02 [95% CI, 1.60-5.71]).
  
  
  CONCLUSIONS
  Women who used antipsychotics during pregnancy had increased risks of gestational diabetes. The increased risks of giving birth to an SGA infant seemed to be an effect of confounders, such as smoking. Except for macrocephaly, olanzapine and/or clozapine exposure was not associated with anabolic fetal growth.
authors: Department of Medicine, Centre for Pharmacoepidemiology, Karolinska Institutet, Stockholm, Sweden. robert.boden@neuro.uu.se
authors: Robert
authors: R
authors: Bodén
authors: Maria
authors: M
authors: Lundgren
authors: Lena
authors: L
authors: Brandt
authors: Johan
authors: J
authors: Reutfors
authors: Helle
authors: H
authors: Kieler
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use; D002508:Cephalometry; D016640:Diabetes, Gestational / Q000139:chemically induced*; D011307:Drug Prescriptions; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D008297:Male; D011247:Pregnancy; D012042:Registries; D012306:Risk; D013548:Sweden
chemical_list: D014150:Antipsychotic Agents