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Some antipsychotics may increase gestational diabetes risk

NEW YORK — Women who continued antipsychotic treatment with olanzapine or quetiapine during pregnancy had an increased risk for gestational diabetes compared with those who discontinued treatment, according to data here and simultaneously published in The American Journal of Psychiatry.

“Despite limited safety information regarding the use of antipsychotic drug treatment during pregnancy, an increasing number of women of reproductive age are treated with antipsychotics in the United States,” Yoonyoung Park, ScD, department of medicine, Brigham and Women’s Hospital and Harvard Medical School, and colleagues wrote. “Understanding the potential risk of developing gestational diabetes and how this risk may vary by the type of antipsychotic used is an important consideration for patients and clinicians.”

Researchers examined the risk for gestational diabetes associated with the continued treatment of aripiprazole, ziprasidone, quetiapine, risperidone and olanzapine among nondiabetic women during pregnancy compared with those who discontinued use.

Park and colleagues evaluated women who were enrolled in Medicaid from 2000 to 2010 and received one or more prescriptions for an antipsychotic drug in the 3-month period before pregnancy. At baseline, there were 1,924 expectant mothers receiving aripiprazole, 673 receiving ziprasidone, 4,533 receiving quetiapine, 1,824 receiving risperidone and 1,425 receiving olanzapine. For each antipsychotic drug, they compared women who continued using antipsychotics with those who discontinued use during the first half of their pregnancy.

Depending on the drug examined, analysis showed that the risk for gestational diabetes ranged from 4.2% to 12% among women who continued antipsychotic use compared with 3.8% to 4.7% among those who discontinued use. The investigators found that those who continued antipsychotic treatment during pregnancy generally had higher comorbidity and longer antipsychotic use at baseline.

Specifically, risk for gestational diabetes among continuers compared with discontinuers was 4.8% vs. 4.5% for aripiprazole, 4.2% vs. 3.8% for ziprasidone, 7.1% vs. 4.1% for quetiapine, 6.4% vs. 4.1% for risperidone and 12% vs. 4.7% for olanzapine. Adjusted relative risk was 0.82 for aripiprazole, 0.76 for ziprasidone, 1.28 for quetiapine, 1.09 for risperidone, and 1.61 for olanzapine, according to the authors. After adjusting for confounders, researchers observed a higher risk for gestational diabetes with olanzapine use (adjusted RR = 1.61; 95% CI, 1.13-2.29) and quetiapine use (adjusted RR = 1.28; 95% CI, 1.01-1.62) but not with use of aripiprazole, ziprasidone or risperidone.

"It is important to consider alternative explanations for these findings," said study coauthor Krista F. Huybrechts, PhD, associate professor of medicine, Brigham and Women's Hospital, Harvard Medical School, said in a press release.

"The main concern is potential factors not captured fully in the data, particularly obesity,” she continued. “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.” – by Savannah Demko

Disclosures: Park reports consulting for Optum. Please see the full study for all other authors’ relevant financial disclosures.