title: Antipsychotic drug use in pregnancy: high dimensional, propensity matched, population based cohort study.
abstract: OBJECTIVE
  To evaluate maternal medical and perinatal outcomes associated with antipsychotic drug use in pregnancy.
  
  
  METHODS
  High dimensional propensity score (HDPS) matched cohort study.
  
  
  METHODS
  Multiple linked population health administrative databases in the entire province of Ontario, Canada.
  
  
  METHODS
  Among women who delivered a singleton infant between 2003 and 2012, and who were eligible for provincially funded drug coverage, those with ≥ 2 consecutive prescriptions for an antipsychotic medication during pregnancy, at least one of which was filled in the first or second trimester, were selected. Of these antipsychotic drug users, 1021 were matched 1:1 with 1021 non-users by means of a HDPS algorithm.
  
  
  METHODS
  The main maternal medical outcomes were gestational diabetes, hypertensive disorders of pregnancy, and venous thromboembolism. The main perinatal outcomes were preterm birth (<37 weeks), and a birth weight <3rd or >97th centile. Conditional Poisson regression analysis was used to generate rate ratios and 95% confidence intervals, adjusting for additionally prescribed non-antipsychotic psychotropic medications.
  
  
  RESULTS
  Compared with non-users, women prescribed an antipsychotic medication in pregnancy did not seem to be at higher risk of gestational diabetes (rate ratio 1.10 (95% CI 0.77 to 1.57)), hypertensive disorders of pregnancy (1.12 (0.70 to 1.78)), or venous thromboembolism (0.95 (0.40 to 2.27)). The preterm birth rate, though high among antipsychotic users (14.5%) and matched non-users (14.3%), was not relatively different (rate ratio 0.99 (0.78 to 1.26)). Neither birth weight <3rd centile or >97th centile was associated with antipsychotic drug use in pregnancy (rate ratios 1.21 (0.81 to 1.82) and 1.26 (0.69 to 2.29) respectively).
  
  
  CONCLUSIONS
  Antipsychotic drug use in pregnancy had minimal evident impact on important maternal medical and short term perinatal outcomes. However, the rate of adverse outcomes is high enough to warrant careful assessment of maternal and fetal wellbeing among women prescribed an antipsychotic drug in pregnancy.
authors.affiliation: Women's College Research Institute; Department of Psychiatry, University of Toronto, Toronto, Ontario M5S 1B2, Canada Institute for Clinical Evaluative Sciences, Toronto, Ontario M4N 3M5 Department of Psychiatry, Women's College Hospital; University of Toronto, Toronto, Ontario simone.vigod@wchospital.ca.
authors.forename: Simone N
authors.initials: SN
authors.lastname: Vigod
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ontario M4N 3M5.
authors.forename: Tara
authors.initials: T
authors.lastname: Gomes
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ontario M4N 3M5.
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Wilton
authors.affiliation: Women's College Research Institute; Department of Psychiatry, University of Toronto, Toronto, Ontario M5S 1B2, Canada Department of Psychiatry, Women's College Hospital; University of Toronto, Toronto, Ontario.
authors.forename: Valerie H
authors.initials: VH
authors.lastname: Taylor
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ontario M4N 3M5 Departments of Medicine and Obstetrics and Gynaecology, St Michael's Hospital, University of Toronto, Toronto, Ontario M5B 1W8.
authors.forename: Joel G
authors.initials: JG
authors.lastname: Ray
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000009:adverse effects*; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D005317:Fetal Growth Retardation / Q000139:chemically induced; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D016555:Matched-Pair Analysis; D016012:Poisson Distribution; D011247:Pregnancy; D011248:Pregnancy Complications / Q000139:chemically induced*; D047928:Premature Birth / Q000139:chemically induced; D057216:Propensity Score; D012044:Regression Analysis; D012307:Risk Factors
chemical_list: D014150:Antipsychotic Agents