Maria Ellfolk1, Maarit K Leinonen2, Mika Gissler2,3,4, Anna-Maria Lahesmaa-Korpinen5, Leena Saastamoinen6, Marja-Leena Nurminen7,8, Heli Malm9,10,11,12. 1. Teratology Information, Department of Emergency Medicine Services, Helsinki University and Helsinki University Hospital, Tukholmankatu 17, 00029, Helsinki, Finland. 2. Information Services Department, Unit of Statistics and Registers, National Institute for Health and Welfare, PL 30, 00271, Helsinki, Finland. 3. Research Centre for Child Psychiatry, University of Turku, Itäinen Pitkäkatu 1, 20520, Turku, Finland. 4. Department of Neurobiology, Care Sciences and Society, Karolinska Institute, SE-141 83, Huddinge, Sweden. 5. Hospital & Health Care, Terveystalo, Jaakonkatu 3 B, 00100, Helsinki, Finland. 6. Research Unit, The Social Insurance Institution, Nordenskiöldinkatu 12, 00250, Helsinki, Finland. 7. Finnish Medicines Agency FIMEA, Mannerheimintie 103b, 00280, Helsinki, Finland. 8. Swedish Medical Products Agency, P.O. Box 26, SE-751 03, Uppsala, Sweden. 9. Teratology Information, Department of Emergency Medicine Services, Helsinki University and Helsinki University Hospital, Tukholmankatu 17, 00029, Helsinki, Finland. heli.malm@hus.fi. 10. Research Centre for Child Psychiatry, University of Turku, Itäinen Pitkäkatu 1, 20520, Turku, Finland. heli.malm@hus.fi. 11. Department of Clinical Pharmacology, Helsinki University and Helsinki University Hospital, PL 20 (Tukholmankatu 8 C), 00014, Helsinki, Finland. heli.malm@hus.fi. 12. Individualized Drug Therapy Research Program, Faculty of Medicine, University of Helsinki, PL 20 (Tukholmankatu 8 C), 00014, Helsinki, Finland. heli.malm@hus.fi.
Abstract
PURPOSE: To study if second-generation antipsychotic (S-GA) use during pregnancy is associated with an increased risk of pregnancy and neonatal complications. METHODS: A population-based birth cohort study using national register data extracted from the "Drugs and Pregnancy" database in Finland, years 1996-2016. The sampling frame included 1,181,090 pregnant women and their singleton births. Women were categorized into three groups: exposed to S-GAs during pregnancy (n = 4225), exposed to first-generation antipsychotics (F-GAs) during pregnancy (n = 1576), and unexposed (no purchases of S-GAs or F-GAs during pregnancy, n = 21,125). Pregnancy outcomes in S-GA users were compared with those in the two comparison groups using multiple logistic regression models. RESULTS: Comparing S-GA users with unexposed ones, the risk was increased for gestational diabetes (adjusted odds ratio, OR 1.43; 95% CI 1.25-1.65), cesarean section (OR 1.35; 95% CI 1.18-1.53), being born large for gestational age (LGA) (OR 1.57; 95% CI 1.14-2.16), and preterm birth (OR 1.29; 95% CI 1.03-1.62). The risk for these outcomes increased further with continuous S-GA use. Infants in the S-GA group were also more likely to suffer from neonatal complications. Comparing S-GA users with the F-GA group, the risk of cesarean section and LGA was higher (OR 1.25, 95% CI 1.03-1.51; and OR 1.89, 95% CI 1.20-2.99, respectively). Neonatal complications did not differ between the S-GA and F-GA groups. CONCLUSIONS: Prenatal exposure to S-GAs is associated with an increased risk of pregnancy complications related to impaired glucose metabolism. Neonatal problems are common and occur similarly in S-GA and F-GA users.
PURPOSE: To study if second-generation antipsychotic (S-GA) use during pregnancy is associated with an increased risk of pregnancy and neonatal complications. METHODS: A population-based birth cohort study using national register data extracted from the "Drugs and Pregnancy" database in Finland, years 1996-2016. The sampling frame included 1,181,090 pregnant women and their singleton births. Women were categorized into three groups: exposed to S-GAs during pregnancy (n = 4225), exposed to first-generation antipsychotics (F-GAs) during pregnancy (n = 1576), and unexposed (no purchases of S-GAs or F-GAs during pregnancy, n = 21,125). Pregnancy outcomes in S-GA users were compared with those in the two comparison groups using multiple logistic regression models. RESULTS: Comparing S-GA users with unexposed ones, the risk was increased for gestational diabetes (adjusted odds ratio, OR 1.43; 95% CI 1.25-1.65), cesarean section (OR 1.35; 95% CI 1.18-1.53), being born large for gestational age (LGA) (OR 1.57; 95% CI 1.14-2.16), and preterm birth (OR 1.29; 95% CI 1.03-1.62). The risk for these outcomes increased further with continuous S-GA use. Infants in the S-GA group were also more likely to suffer from neonatal complications. Comparing S-GA users with the F-GA group, the risk of cesarean section and LGA was higher (OR 1.25, 95% CI 1.03-1.51; and OR 1.89, 95% CI 1.20-2.99, respectively). Neonatal complications did not differ between the S-GA and F-GA groups. CONCLUSIONS: Prenatal exposure to S-GAs is associated with an increased risk of pregnancy complications related to impaired glucose metabolism. Neonatal problems are common and occur similarly in S-GA and F-GA users.
Authors: Marlene P Freeman; Alexandra Z Sosinsky; Lina Goez-Mogollon; Gina M Savella; Danna Moustafa; Adele C Viguera; Lee S Cohen Journal: Psychosomatics Date: 2017-09-21 Impact factor: 2.386
Authors: Amber N Edinoff; Niroshan Sathivadivel; Shawn E McNeil; Austin I Ly; Jaeyeon Kweon; Neil Kelkar; Elyse M Cornett; Adam M Kaye; Alan D Kaye Journal: Neurol Int Date: 2022-01-03
Authors: Maria Ellfolk; Maarit K Leinonen; Mika Gissler; Sonja Kiuru-Kuhlefelt; Leena Saastamoinen; Heli Malm Journal: Eur J Clin Pharmacol Date: 2021-06-08 Impact factor: 2.953