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Prenatal Antipsychotic Exposure May Not Meaningfully Increase Neurodevelopmental Risk
The increased risk of neurodevelopmental disorders in children exposed to antipsychotic drugs late in pregnancy may stem from maternal characteristics rather than the antipsychotic exposure, suggests a study published in JAMA Internal Medicine.
“This finding highlights the importance of closely monitoring the neurodevelopment of the offspring of women with mental illness to ensure early intervention and support,” wrote lead author Loreen Straub, MD, MS, of Brigham and Women’s Hospital and Harvard Medical School in Boston, and coauthors.
The birth cohort study included 3.4 million children from the Medicaid Analytic eXtract and the IBM Health MarketScan Research Database with up to 14 years of follow-up. Antipsychotic drug dispensing during the second half of pregnancy occurred with 9551 pregnancies in Medicaid Analytic eXtract cohort and 1221 pregnancies in the IBM Health MarketScan Research Database cohort.
According to the study, unadjusted analysis showed an approximately 2-fold increased risk for neurodevelopment disorders with prenatal antipsychotic exposure. However, increased risks were no longer meaningful after researchers adjusted for maternal treatment indications and other potential confounders, with the exception of aripiprazole. After adjustment, the hazard ratio for any neurodevelopment disorder after prenatal antipsychotic exposure was 1.08. With aripiprazole, the hazard ratio for any neurodevelopment disorder was 1.36.
“The findings of this birth cohort study suggest that antipsychotic medications may not have important neurotoxic effects; the potential signal identified for aripiprazole requires replication in other data before causality can be assumed,” researchers wrote.
Additional Clinical Insights
At Psych Congress 2022, Joseph Goldberg, MD, addressed this topic specifically regarding women of child-bearing age that are rapid cycling. Listen to the podcast for specific treatment information, including altering medication therapies and potential contraindications.
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