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The use of antipsychotic agents during pregnancy and the risk of gestational diabetes mellitus: a systematic review and meta-analysis

Published online by Cambridge University Press:  23 January 2020

Z. Wang ,
I.C.K. Wong ,
K.K.C. Man ,
B.H. Alfageh ,
P. Mongkhon  and
R. Brauer
Z. Wang*
Affiliation:
Research Department of Practice and Policy, UCL School of Pharmacy, London, UK
I.C.K. Wong
Affiliation:
Research Department of Practice and Policy, UCL School of Pharmacy, London, UK Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, Centre for Safe Medication Practice and Research, The University of Hong Kong, Hong Kong, China
K.K.C. Man
Affiliation:
Research Department of Practice and Policy, UCL School of Pharmacy, London, UK Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, Centre for Safe Medication Practice and Research, The University of Hong Kong, Hong Kong, China
B.H. Alfageh
Affiliation:
Research Department of Practice and Policy, UCL School of Pharmacy, London, UK College of Pharmacy, King Saud University, Riyadh, Kingdom of Saudi Arabia
P. Mongkhon
Affiliation:
Research Department of Practice and Policy, UCL School of Pharmacy, London, UK School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand
R. Brauer
Affiliation:
Research Department of Practice and Policy, UCL School of Pharmacy, London, UK
*
Author for correspondence: Z. Wang, E-mail: [email protected]
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Abstract

Background

Previous studies have found contradicting results with regard to the use of antipsychotics during pregnancy and the risk of gestational diabetes mellitus (GDM). We aimed to evaluate the association between antipsychotic use in pregnancy and GDM.

Methods

A systematic literature search was conducted in PubMed, EMBASE, PsycINFO and Cochrane Library databases up to March 2019, for data from observational studies assessing the association between gestational antipsychotic use and GDM. Non-English studies, animal studies, case reports, conference abstracts, book chapters, reviews and summaries were excluded. The primary outcome was GDM. Estimates were pooled using a random effect model, with the I2 statistic used to estimate heterogeneity of results. Our study protocol was registered with PROSPERO number: CRD42018095014.

Results

In total 10 cohort studies met the inclusion criteria in our systematic review with 6642 exposed and 1 860 290 unexposed pregnancies. Six studies were included in the meta-analysis with a pooled adjusted relative risk of 1.24 overall [95% confidence interval (CI) 1.09–1.42]. The I2 result suggested low heterogeneity between studies (I2 = 6.7%, p = 0.373).

Conclusion

We found that the use of antipsychotic medications during pregnancy is associated with an increased risk of GDM in mothers. However, the evidence is still insufficient, especially for specific drug classes. We recommend more studies to investigate this association for specific drug classes, dosages and comorbidities to help clinicians to manage the risk of GDM if initiation or continuation of antipsychotic prescriptions during pregnancy is needed.

Keywords

Antipsychoticsgestational diabetespregnancy
Type
Original Articles
Information
Psychological Medicine , Volume 51 , Issue 6 , April 2021 , pp. 1028 - 1037
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Copyright
Copyright © Cambridge University Press 2020

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