title: Risks associated with antipsychotic treatment in pregnancy: Comparative cohort studies based on electronic health records.
abstract: Limited information is available on whether antipsychotics prescribed in pregnancy are associated with increased risks of adverse outcomes.
  
  
  
  We used electronic health records from pregnant women and their children to examine risks of adverse maternal and child outcomes in three cohorts of women who: (A) received antipsychotic treatment in pregnancy (n=416) (B) discontinued antipsychotic treatment before pregnancy (n=670), and (C) had no records of antipsychotic treatment before or during pregnancy (n=318,434). Absolute and risk ratios were estimated and adjusted for health and lifestyle and concomitant medications.
  
  
  
  Caesarean section was more common in cohort A (25%) than C (18%), but non-significant after adjustment for health and lifestyle factors (Risk Ratio (adj.) 1.09 (95% CI: 0.92, 1.30). Proportion of gestational diabetes was similar in cohort A (2.6%) and B (2.7%), but lower in A than B after adjustments (RRadj: 0.43 (0.20, 0.93). Premature birth/low birthweight were more common in cohort A (10%) than B (4.3%) and C (3.9%), A versus B (RRadj: 2.04 (1.13, 3.67), A versus C (RRadj: 1.43 (0.99, 2.05). Major congenital malformations were more common in A (3.4%), than B (2.2%) and C (2%). However no significant difference was observed (A versus B: RRadj: 1.79 (0.72, 4.47) A versus C RRadj: 1.59 (0.84, 3.00)). Risks estimates were similar for women prescribed atypical and typical antipsychotics.
  
  
  
  Antipsychotic treatment in pregnancy carries limited risks of adverse pregnancy and birth outcomes once adjustments have been made for health and lifestyle factors.
authors.affiliation: Department of Primary Care and Population Health, UCL, Rowland Hill St., London NW3 2PF, UK; Department of Clinical Epidemiology, Aarhus University, Olof Palmes Allé 43-45, 8200 Aarhus N, Denmark. Electronic address: i.petersen@ucl.ac.uk.
authors.forename: Irene
authors.initials: I
authors.lastname: Petersen
authors.affiliation: Department of Primary Care and Population Health, UCL, Rowland Hill St., London NW3 2PF, UK.
authors.forename: Cormac J
authors.initials: CJ
authors.lastname: Sammon
authors.affiliation: Department of Primary Care and Population Health, UCL, Rowland Hill St., London NW3 2PF, UK.
authors.forename: Rachel L
authors.initials: RL
authors.lastname: McCrea
authors.affiliation: Division of Psychiatry, UCL, 6th Floor, Maple House, 149 Tottenham Court Road, London W1T 7NF, UK; Camden and Islington NHS Foundation Trust, London NW10PE, UK.
authors.forename: David P J
authors.initials: DPJ
authors.lastname: Osborn
authors.affiliation: Department of Medical Statistics, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Evans
authors.affiliation: University Department of Psychiatry, Warneford Hospital, Oxford OX37JX, UK.
authors.forename: Phillip J
authors.initials: PJ
authors.lastname: Cowen
authors.affiliation: Department of Primary Care and Population Health, UCL, Rowland Hill St., London NW3 2PF, UK.
authors.forename: Irwin
authors.initials: I
authors.lastname: Nazareth
mesh_terms: D000293:Adolescent; D000328:Adult; D014150:Antipsychotic Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D002585:Cesarean Section; D002648:Child; D015331:Cohort Studies; D000013:Congenital Abnormalities / Q000453:epidemiology; D016640:Diabetes, Gestational; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D007230:Infant, Low Birth Weight; D008297:Male; D008875:Middle Aged; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy* / Q000453:epidemiology*; D047928:Premature Birth / Q000453:epidemiology; D012306:Risk; D055815:Young Adult
chemical_list: D014150:Antipsychotic Agents
keywords: Antipsychotic treatment; Electronic health records; Pregnancy