Antipsychotic Use During Pregnancy Linked to Higher Risk for Gestational Diabetes

Krista F. Huybrechts, MS, PhD

Women that have been exposed to certain antipsychotic medications and continue using them throughout pregnancy could be at a higher risk for developing gestational diabetes.

In a presentation at the American Psychiatric Association’s annual meeting in New York City, findings were presented that revealed that the absolute risk of gestational diabetes for those who continued to use aripiprazole (Abilify, Otsuka), ziprasidone (Geodon, Pfizer), quetiapine (Seroquel, AstraZeneca), risperidone (Risperdal, Janssen) and olanzapine (Zyprexa, Eli lilly), during pregnancy was 4.2% to 12% compared to 3.8% to 4.7% for those who stopped medication during pregnancy.

“It is important to consider alternative explanations for these findings,” coauthor Krista F. Huybrechts, MS, PhD, an associate professor of medicine at Brigham and Women’s Hospital and Harvard Medical School, said in a statement. “The main concern is potential factors not captured fully in the data, particularly obesity. However, 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.”

Antipsychotic medications have long been linked to adverse metabolic effects, such as weight gain and diabetes, which are risk factors for gestational diabetes themselves. Approximately 50% of women with gestational diabetes end up developing type 2 diabetes.

The study examination included data from 1,543,334 pregnancies from the Medicaid Analytic eXtract database from 2000 to 2010. In total, 10,379 mothers on antipsychotics were included—aripiprazole (n = 1924), ziprasidone (n = 673), quetiapine (n = 4533), risperidone (n = 1,824), or olanzapine (n = 1425). Each participant included that continued using their medication during the first half of pregnancy was compared with those that did not.

“We did not observe a difference in the risk for gestational diabetes when comparing women who continued treatment with aripiprazole, ziprasidone, and risperidone with women who discontinued treatment with these antipsychotics,” the authors wrote. “Further studies are needed in order to understand the potential effect of switching antipsychotic agents during pregnancy on the risk for gestational diabetes.”

Those that continued use had generally higher comorbidity and longer baseline antipsychotic use. The crude risk of developing gestational diabetes among continuers compared with discontinuers, respectively, was as follows:

• 4.8% (n = 419) and 4.5% (n = 1505) for aripiprazole.
• 4.2% (n = 167) and 3.8% (n = 506) for ziprasidone.
• 7.1% (n = 1543) and 4.1% (n = 2990) for quetiapine.
• 6.4% (n = 359) and 4.1% (n = 1465) for risperidone.
• 12.0% (n = 384) and 4.7% (n = 1041) for olanzapine.

The adjusted relative risks were 0.82 (95% CI, 0.50 to 1.33) for aripiprazole, 0.76 (95% CI, 0.29 to 2.00) for ziprasidone, 1.28 (95% CI, 1.01to 1.62) for quetiapine, 1.09 (95% CI, 0.70 to 1.70) for risperidone, and 1.61 (95% CI, 1.13 to 2.29) for olanzapine.

“Such information would aid treatment decisions pertaining to women for whom treatment discontinuation is not an option,” Huybrechts and colleagues wrote. “Although the risk for gestational diabetes is an important consideration in the selection of a specific drug, other dimensions of antipsychotic treatment, including the benefit of continuing a specific treatment and the risk of efficacy loss due to changes in treatment, should be taken into account in the treatment decisions for pregnant women.”

The study, “Continuation of Atypical Antipsychotic Medication During Early Pregnancy and the Risk of Gestational Diabetes,” was published in the American Journal of Psychiatry.

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