Neonatal morbidity after fetal exposure to antipsychotics: a national register-based study
Objective To investigate the admission rate to neonatal care and neonatal morbidity after maternal use of antipsychotics during pregnancy.Design A population-based register study.Setting Information on all singleton births between July 2006 and December 2017 in Sweden including data on prescription...
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BMJ Publishing Group
2022-06-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/12/6/e061328.full |
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| author | Karin Kallen Lisa Forsberg Essi Heinonen Katarina Wide Ulrika Nörby |
| author_facet | Karin Kallen Lisa Forsberg Essi Heinonen Katarina Wide Ulrika Nörby |
| author_sort | Karin Kallen |
| collection | DOAJ |
| description | Objective To investigate the admission rate to neonatal care and neonatal morbidity after maternal use of antipsychotics during pregnancy.Design A population-based register study.Setting Information on all singleton births between July 2006 and December 2017 in Sweden including data on prescription drugs, deliveries and infants’ health was obtained from the Swedish Medical Birth Register, the Prescribed Drug Register and the Swedish Neonatal Quality Register. Exposed infants were compared with unexposed infants and with infants to mothers treated with antipsychotics before or after but not during pregnancy.Participants The cohort comprised a total of 1 307 487 infants, of whom 2677 (0.2%) were exposed to antipsychotics during pregnancy and 34 492 (2.6%) had mothers who were treated before/after the pregnancy.Outcome measures The primary outcome was admission rate to neonatal care. Secondary outcomes were the separate neonatal morbidities.Results Of the exposed infants, 516 (19.3%) were admitted to neonatal care compared with 98 976 (7.8%) of the unexposed infants (adjusted risk ratio (aRR): 1.7; 95% CI: 1.6 to 1.8), with a further increased risk after exposure in late pregnancy. The highest relative risks were seen for withdrawal symptoms (aRR: 17.7; 95% CI: 9.6 to 32.6), neurological disorders (aRR: 3.4; 95% CI: 2.4 to 5.7) and persistent pulmonary hypertension (aRR: 2.1; 95% CI: 1.4 to 3.1) when compared with unexposed infants. The absolute risks for these outcomes were however low among the exposed infants, 1.3%, 1.8% and 1.0%, respectively, and the relative risks were lower when compared with infants to mothers treated before/after the pregnancy.Conclusion Fetal exposure to antipsychotics was associated with an increased risk of neonatal morbidity. The effects in the exposed infants seem transient and predominantly mild, and these findings do not warrant discontinuation of a necessary treatment but rather increased monitoring of these infants. The increased risk of persistent pulmonary hypertension requires further studies. |
| format | Article |
| id | doaj-art-6bdec4a1eb594ab38e015dbf31252058 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2022-06-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-6bdec4a1eb594ab38e015dbf312520582025-01-24T15:10:15ZengBMJ Publishing GroupBMJ Open2044-60552022-06-0112610.1136/bmjopen-2022-061328Neonatal morbidity after fetal exposure to antipsychotics: a national register-based studyKarin Kallen0Lisa Forsberg1Essi Heinonen2Katarina Wide3Ulrika Nörby4Department of Clinical Sciences, Centre of Reproduction Epidemiology, Tornblad Institute, Lund University, Lund, SwedenOxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, Oxford, UKDepartment of Clinical Sciences Intervention and Technology, Karolinska Institutet, Stockholm, SwedenDepartment of Clinical Sciences Intervention and Technology, Karolinska Institutet, Stockholm, SwedenDepartment of Clinical Sciences, Centre of Reproduction Epidemiology, Tornblad Institute, Lund University, Lund, SwedenObjective To investigate the admission rate to neonatal care and neonatal morbidity after maternal use of antipsychotics during pregnancy.Design A population-based register study.Setting Information on all singleton births between July 2006 and December 2017 in Sweden including data on prescription drugs, deliveries and infants’ health was obtained from the Swedish Medical Birth Register, the Prescribed Drug Register and the Swedish Neonatal Quality Register. Exposed infants were compared with unexposed infants and with infants to mothers treated with antipsychotics before or after but not during pregnancy.Participants The cohort comprised a total of 1 307 487 infants, of whom 2677 (0.2%) were exposed to antipsychotics during pregnancy and 34 492 (2.6%) had mothers who were treated before/after the pregnancy.Outcome measures The primary outcome was admission rate to neonatal care. Secondary outcomes were the separate neonatal morbidities.Results Of the exposed infants, 516 (19.3%) were admitted to neonatal care compared with 98 976 (7.8%) of the unexposed infants (adjusted risk ratio (aRR): 1.7; 95% CI: 1.6 to 1.8), with a further increased risk after exposure in late pregnancy. The highest relative risks were seen for withdrawal symptoms (aRR: 17.7; 95% CI: 9.6 to 32.6), neurological disorders (aRR: 3.4; 95% CI: 2.4 to 5.7) and persistent pulmonary hypertension (aRR: 2.1; 95% CI: 1.4 to 3.1) when compared with unexposed infants. The absolute risks for these outcomes were however low among the exposed infants, 1.3%, 1.8% and 1.0%, respectively, and the relative risks were lower when compared with infants to mothers treated before/after the pregnancy.Conclusion Fetal exposure to antipsychotics was associated with an increased risk of neonatal morbidity. The effects in the exposed infants seem transient and predominantly mild, and these findings do not warrant discontinuation of a necessary treatment but rather increased monitoring of these infants. The increased risk of persistent pulmonary hypertension requires further studies.https://bmjopen.bmj.com/content/12/6/e061328.full |
| spellingShingle | Karin Kallen Lisa Forsberg Essi Heinonen Katarina Wide Ulrika Nörby Neonatal morbidity after fetal exposure to antipsychotics: a national register-based study BMJ Open |
| title | Neonatal morbidity after fetal exposure to antipsychotics: a national register-based study |
| title_full | Neonatal morbidity after fetal exposure to antipsychotics: a national register-based study |
| title_fullStr | Neonatal morbidity after fetal exposure to antipsychotics: a national register-based study |
| title_full_unstemmed | Neonatal morbidity after fetal exposure to antipsychotics: a national register-based study |
| title_short | Neonatal morbidity after fetal exposure to antipsychotics: a national register-based study |
| title_sort | neonatal morbidity after fetal exposure to antipsychotics a national register based study |
| url | https://bmjopen.bmj.com/content/12/6/e061328.full |
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