Some Antipsychotic Medications Can Increase Gestational Diabetes Risk

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Some Antipsychotic Medications Can Increase Gestational Diabetes Risk

According to which antipsychotic medications they take, expectant mothers appear to face an increased risk of developing gestational diabetes, according to a new study which reviewed common drugs and determined relative risks. Here are the results, including some important information pharmacists need to know.

BOSTON – Taking certain antipsychotic medications and continuing them through pregnancy can increase risk of gestational diabetes in expectant mothers, a new study reveals.

The report published online by the American Journal of Psychiatry said past research has shown a link between antipsychotic medication metabolic side effects, such as weight gain and diabetes, but this is the first study to establish a clear link with gestational diabetes.

https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2018.17040393

Research was conducted by a team from Brigham and Women's Hospital, Harvard Medical School, Harvard School of Public Health and Massachusetts General Hospital, all in Boston.

The study team looked at the risk of developing gestational diabetes associated with continued use of several antipsychotic medications, including aripiprazole, ziprasidone, quetiapine, risperidone and olanzapine during pregnancy.

Included in the analysis were nondiabetic pregnant women who were linked to a live-born infant and enrolled in Medicaid (2000–2010) and who also received one or more prescriptions dispensed for an antipsychotic drug during the three months before pregnancy. For each antipsychotic drug, women with two or more dispensed prescriptions "continuers" were compared to women with no dispensings "discontinuers" during the first half of the pregnancy.

Results indicate that women who continued antipsychotic treatment during pregnancy generally had higher comorbidity and longer baseline antipsychotic use. Researchers report that the crude risk of developing gestational diabetes among continuers compared with discontinuers, respectively, was:

  • 4.8% and 4.5% for aripiprazole, adjusted relative risk of 0.82;
  • 4.2% and 3.8% for ziprasidone, adjusted relative risk of 0.76;
  • 7.1% and 4.1% for quetiapine, adjusted relative risk of 1.28;
  • 6.4% and 4.1% for risperidone, adjusted relative risk of 1.09, and
  • 12.0% and 4.7% for olanzapine, adjusted relative risk of 1.61.

Based on the specific medication, the absolute risk of gestational diabetes among the study participants continuing medication was 4.2% to 12% vs.3.8% to 4.7% among those stopping the medications.

"Compared with women who discontinued use of an atypical antipsychotic medication before the start of pregnancy, women who continued treatment with olanzapine or quetiapine had an increased risk of gestational diabetes that may be explained by the metabolic effects associated with these two drugs," study authors concluded.

"It is important to consider alternative explanations for these findings," added study coauthor Krista F. Huybrechts, MS, PhD, of Brigham and Women's Hospital and Harvard Medical School. "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."

Gestational diabetes can lead to preeclampsia, the necessity of cesarean delivery and neonatal hypoglycemia, background information in the study notes. As many as 9% of women develop gestational diabetes during pregnancy, and up to 50% of those later develop type 2 diabetes, the researchers point out.

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