Prenatal Exposure to Antipsychotics Not Linked to ADHD, ASD, Preterm Birth

New findings suggest no association between prenatal exposure to antipsychotics and attention/deficit/hyperactivity disorder (ADHD) or autism spectrum disorder (ASD), preterm birth, and small for gestational age. Researchers published their findings of the population-based cohort study online ahead of print in JAMA Internal Medicine.

"Our study results suggest that if pregnant women have a clinical need for antipsychotics (including first and second-generation antipsychotics), clinicians should not stop administering regular treatment because of a fear of birth outcomes with ADHD, ASD, preterm birth, and small for gestational age," wrote Zixuan Wang, MSc, UCL School of Pharmacy, London, England, et al.

Researchers examined 411 251 pairs of mother-child records for ASD, preterm birth, and small-for-gestational-age analyses, and 333 749 pairs of ADHD analyses. Of children analyzed, 3.95% had a diagnosis of ADHD, 8715 had a diagnosis of ASD, 33 891 were preterm, and 7009 were small for gestational age. Preterm birth was defined as less than 37 gestational weeks, small for gestational age was defined as a birth weight of less than 2 SDs below the mean for gestational age—both were identified and recorded at the delivery date.

Of children studied, 706 were prenatally exposed to antipsychotics, and 27 received the following diagnoses: ASD (3.82%), preterm birth (13.03%), and small for gestational age (2.69%). In addition, 547 of the studied children were exposed.

The weighted hazard ratio (wHR) was 1.16 for ADHD, 1.06 for ASD, 1.40 for preterm birth. When comparing gestationally exposed to non-exposed individuals for small gestational age, the wHR was 1.36.

Alcohol, Tobacco Use During Lactation Not Linked to ADHD

Among pregnant women who were never exposed to psychiatric drugs, children of mothers with psychiatric disorders were found to have a higher risk of neurodevelopmental disorders, including ADHD and ASD, compared with those with mothers with psychiatric disorders. These findings suggest maternal psychiatric disorders are linked with a higher risk of the studied conditions, but exposure to antipsychotics is unlikely to increase risk. Additional examination showed no association when comparing sibling-matched analysis.

"Given that maternal psychiatric disorders may increase neurodevelopmental disorder risk in children, 25 clinicians should inform individual patients about the benefits and potential risks of using antipsychotics during pregnancy," researchers concluded.

—Meagan Thistle

Reference

Wang Z, Chan AYL, Coghill D, et al. Association between prenatal exposure to antipsychotics and attention-deficit/hyperactivity disorder, autism spectrum disorder, preterm birth, and small for gestational age. JAMA Intern Med. Published online August 16, 2021.