title: Risk of Fetal Death after Treatment with Antipsychotic Medications during Pregnancy.
abstract: BACKGROUND
  Antipsychotic medications are increasingly used during pregnancy. Nevertheless, fetal risks are still not fully studied. It is currently unclear whether the antipsychotic treatment might induce a higher risk of fetal death. We aimed to determine if use of antipsychotic medication during pregnancy is associated with an increased risk of spontaneous abortion or stillbirth.
  
  
  METHODS
  In a historical cohort study, we identified all clinically recognized pregnancies registered in the nationwide Danish registries from 1997 to 2008 (N = 1,005,319). Exposure was defined as any prescription of antipsychotic medications redeemed by the pregnant women during the exposure window, and recorded in the Danish National Prescription Register. Outcome was defined as any spontaneous abortion or stillbirth recorded in the Danish National Hospital Register and the Danish Medical Birth Register respectively.
  
  
  RESULTS
  Women exposed to antipsychotic medications during pregnancy had a 34% higher risk of spontaneous abortion (adjusted relative risk = 1.34; 95% confidence interval = 1.22; 1.46) compared to unexposed women, but a similar risk compared to women exposed prior to (but not during) pregnancy (adjusted relative risk = 1.04; 95% confidence interval = 0.93; 1.17). The risk of spontaneous abortion was not increased in exposed pregnancies when compared to unexposed pregnancies in the same women (adjusted hazard ratio = 1.11; 95% CI = 0.94; 1.31). A twofold higher risk of stillbirth was found in women exposed to antipsychotic medications compared with unexposed women (relative risk = 2.27; 95% confidence interval = 1.45; 3.55) and compared with women exposed only prior to pregnancy (relative risk = 2.06; 95% confidence interval = 1.01; 4.19).
  
  
  CONCLUSIONS
  The increased risk of spontaneous abortion found in women treated with antipsychotic medications during pregnancy is most likely due to confounding factors. The risk of stillbirth was twofold higher in pregnancies exposed to antipsychotic medication during pregnancy. Treatment with antipsychotic medications during pregnancy requires careful consideration.
authors.affiliation: Regional Center for Child and Adolescent Psychiatry, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Merete Juul
authors.initials: MJ
authors.lastname: Sørensen
authors.affiliation: Section for Biostatistics, Department of Public Health, Aarhus University, Aarhus, Denmark.
authors.forename: Maiken Ina Siegismund
authors.initials: MI
authors.lastname: Kjaersgaard
authors.affiliation: Research Unit for General Practice, Department of Public Health, Aarhus University, Aarhus, Denmark.
authors.forename: Henrik Søndergaard
authors.initials: HS
authors.lastname: Pedersen
authors.affiliation: Research Unit for General Practice, Department of Public Health, Aarhus University, Aarhus, Denmark; Section for General Medical Practice, Department of Public Health, Aarhus University, Aarhus, Denmark.
authors.forename: Mogens
authors.initials: M
authors.lastname: Vestergaard
authors.affiliation: Department of Neurology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Pharmacology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Jacob
authors.initials: J
authors.lastname: Christensen
authors.affiliation: Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark.
authors.forename: Jørn
authors.initials: J
authors.lastname: Olsen
authors.affiliation: Section for Biostatistics, Department of Public Health, Aarhus University, Aarhus, Denmark.
authors.forename: Erik
authors.initials: E
authors.lastname: Parner
authors.affiliation: Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark; Institute of Clinical Medicine-Obstetrics and Gynaecology, Aarhus University, Aarhus, Denmark.
authors.forename: Lars Henning
authors.initials: LH
authors.lastname: Pedersen
authors.affiliation: Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark.
authors.forename: Bodil Hammer
authors.initials: BH
authors.lastname: Bech
mesh_terms: D000022:Abortion, Spontaneous / Q000139:chemically induced; D000328:Adult; D014150:Antipsychotic Agents / Q000009:adverse effects*; D005260:Female; D005313:Fetal Death / Q000209:etiology*; D006801:Humans; D011247:Pregnancy; D011256:Pregnancy Outcome; D012307:Risk Factors; D050497:Stillbirth; D055815:Young Adult
chemical_list: D014150:Antipsychotic Agents