Women who continue treatment with certain antipsychotics during the fist half of their pregnancy may be at increased risk of gestational diabetes compared to those who discontinue antipsychotic use, according to a new study published in the American Journal of Psychiatry.
For this study, researchers sought to explore the known metabolic side effects of antipsychotics in relation to gestational diabetes. Medicaid data from 2000 to 2010 was used to identify nondiabetic pregnant women who had received ≥1 antipsychotic prescription during the 3 months prior to pregnancy. Those who had ≥2 dispensings were then compared to women who discontinued treatment.
The treatments received included aripiprazole (Abilify, N=1,924), ziprasidone (Geodon, N=673), quetiapine (Seroquel, N=4,533), risperidone (Risperdal, N=1,824), and olanzapine (Zyprexa, N=1,425). Results showed there was a significant crude risk linked to continuing vs discontinuing certain antipsychotics and developing gestational diabetes; for quetiapine the risk was 7.1% vs 4.1% (adjusted relative risk [ARR] 1.28), respectively; among olanzapine users it was 12% vs 4.7% (ARR 1.61), respectively.
The risk of gestational diabetes was also greater for those who continued treatment in the other 3 treatment groups, but it was not considered significant. For continuers vs discontinuers of risperidone the risk was 6.4% vs 4.1% (ARR 1.09); for aripiprazole it was 4.8% vs 4.5% (ARR 0.82); and for ziprasidone it was 4.2% vs 3.8% (ARR 0.76), respectively.
Questioning whether there was an alternative explanation for the study findings, such as obesity, co-author Krista F. Huybrechts, MS, PhD, said, “We demonstrated that the imbalance in the obesity prevalence between those continuing treatment and those discontinuing would have to be very high to fully explain the increased risk. This seems unlikely given that all women were treated before the start of pregnancy and we accounted for a broad range of proxy variables.”
The authors did acknowledge that in deciding upon medication discontinuation, diabetes risk is just one of many factors to consider; the benefits of the medication and the risks associated with discontinuing should also be considered. Further research into switching antipyschotics during pregnancy would help in these decisions, they concluded.
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