TOPLINE:

Discontinuation of antipsychotic treatment during pregnancy was associated with a 60% increased risk for severe psychiatric relapse compared with continuation of treatment in women with primary psychotic disorders, a new cohort study showed. Although no significant risk for discontinuation was found in women with bipolar disorder, the statistical power for this finding was limited, the researchers noted.

METHODOLOGY:

• A population-based cohort study used data from linked national birth registers to identify pregnancies leading to singleton live births from 1998 to 2022 in Denmark and from 2007 to 2017 in Sweden.
• Study participants included 2000 women with primary psychotic disorders (mean age, 31 years) and nearly 1300 women with bipolar disorder (mean age, 29 years) who had at least two antipsychotic prescriptions within a year before pregnancy. Those who discontinued antipsychotics before or during pregnancy were propensity score matched (1:1) to those who continued taking these drugs throughout the prenatal period.
• Discontinuation was defined as no prescription refill within the expected prescription duration with an additional 60-day grace period.
• The primary outcome was severe psychiatric relapse during the perinatal period, defined as inpatient treatment for psychiatric disorders during pregnancy and up to 90 days postpartum. The analysis was adjusted for factors such as maternal demographics, health status, history of psychiatric disorders, and co-prescribed medication.

TAKEAWAY:

• Discontinuation of antipsychotics before or during pregnancy was more common in women with bipolar disorder (83% in Denmark and 89% in Sweden) than those with psychotic disorders (80% in Denmark and 78% in Sweden).
• In women with psychotic disorders, discontinuation of antipsychotics during pregnancy was associated with a higher risk for severe relapse than continuation (adjusted hazard ratio [aHR], 1.60; 95% CI, 1.01-2.54), while discontinuation before pregnancy was associated with a nonsignificantly higher relapse risk (aHR, 1.24; 95% CI, 0.82-1.90).
• In women with bipolar disorder, discontinuation of antipsychotics before or during pregnancy was not associated with a significant increase in risk for severe relapse (aHRs, 0.50 and 1.0, respectively).

IN PRACTICE:

“Addressing questions about medication changes before and during pregnancy is complicated by the limitations of existing data sources,” noted authors of an accompanying editorial.

“Creative strategies, like defining cohorts intending pregnancy or identifying pregnancies that do not end in live births, will often be needed to answer questions about pregnancy from available data and to learn about the effects of decisions about medication use during this period,” they added.

SOURCE:

This study was led by Xiaoqin Liu, PhD, The National Centre for Register-based Research, Aarhus University, Aarhus, Denmark, and Shelby Smout, PhD, Icahn School of Medicine at Mount Sinai, New York City. Lead author of the editorial was Mollie E. Wood, PhD, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill. Both articles were published online on March 27 in JAMA Network Open.

LIMITATIONS:

This study was limited by potential misclassification, potential residual confounding, exclusion of women without propensity matches, exclusion of nonsevere relapses, and a limited sample size, particularly for bipolar disorder. Additionally, this study was restricted to pregnancies resulting in live births, which may have introduced a selection bias.

DISCLOSURES:

This study was funded by the National Institute of Mental Health and the National Institute of Child Health and Human Development. Disclosure information for the study investigators and editorialists is available in the original articles.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.