A new study finds that women who continue taking the atypical antipsychotic drugs olanzapine (Zyprexa) and quetiapine (Seroquel) during pregnancy are at an increased risk for gestational diabetes.
The findings are published in the American Journal of Psychiatry.
Antipsychotic medications are commonly used to treat bipolar disorder, schizophrenia and other severe mental health disorders. While it is well-established that these medications carry a greater risk for metabolic side effects including weight gain and diabetes in the general population, whether the continued use of such drugs during pregnancy could lead to an increased risk of gestational diabetes is not known.
In a new study, researchers from Brigham and Women’s Hospital (BWH), Harvard Medical School, Harvard School of Public Health and Massachusetts General Hospital addressed the link between antipsychotic treatment during pregnancy and the risk for gestational diabetes.
The study involved women without pre-existing diabetes who had been taking antipsychotic drugs during the three months before pregnancy. The researchers then compared those who continued to take medication during the first half of pregnancy to women who stopped taking the medication during pregnancy.
Gauging this risk is important, as approximately 50 percent of women with gestational diabetes will go on to develop type 2 diabetes in the years following pregnancy. Gestational diabetes is also linked to negative pregnancy outcomes, including preeclampsia, cesarean delivery, neonatal hypoglycemia and macrosomia.
For the study, the researchers focused on five atypical antipsychotics: aripiprazole (Abilify), ziprasidone (Geodon), quetiapine (Seroquel), risperidone (Risperdal), and olanzapine (Zyprexa). Their findings reveal that continuation of olanzapine and quetiapine showed an increased risk for gestational diabetes compared with women who discontinued these medications.
However, the use of aripiprazole, ziprasidone, and risperidone during pregnancy was not associated with an increased risk of gestational diabetes.
“The risks of gestational diabetes observed during pregnancy are in line with expectations based on the metabolic side effects observed in the general population,” said senior author Krista F. Huybrechts, M.S., Ph.D., an epidemiologist in the Division of Pharmacoepidemiology and Pharmacoeconomics at BWH. “Certain antipsychotics have different levels of risk of metabolic side effects.”
Continuation of quetiapine led to a 28 percent increased risk, corresponding to 1.6 extra cases of gestational diabetes per 100 women treated. Continuation of olanzapine led to a 61 percent increased risk, corresponding to 4.4 extra cases of gestational diabetes per 100 women treated.
The researchers accounted for a wide range of variables, so they are confident that the increased risks are not due to confounding by incomplete overweight or obesity measurements at the start of pregnancy.
“Clinicians must weigh the benefits of staying on a stable regimen against the risks of continuing treatment with a higher-risk atypical antipsychotic during pregnancy to make an informed decision about the best course of treatment for the patient in question,” said Huybrechts.
Source: Brigham and Women’s Hospital
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