Taking antipsychotics during pregnancy did not affect the neuropsychiatric development of children

A population-based cohort study by Australian, Danish, Norwegian, Finnish and Swedish scientists found that mothers taking antipsychotic drugs during pregnancy did not practically increase the risk of neurodevelopmental disorders in children, including the risk of learning difficulties. As reported in the journal eClinicalMedicine, the study used data from more than 210,000 children.

Neuroleptics, which are primarily indicated for schizophrenia and bipolar disorder, are often prescribed, including to pregnant women, to treat anxiety, depression and to correct behavior in autism spectrum disorders. However, animal studies have shown that prenatal exposure to certain antipsychotic drugs, including haloperidol, risperidone, quetiapine and olanzapine, can cause damage to fetal neural tissue. However, the extent to which antipsychotic drugs penetrate the placenta and accumulate in fetal brain tissue varies depending on the specific drug.

Data on the long-term neural development of children whose mothers took neuroleptics during pregnancy are still scarce. However, even the available data show that taking these drugs did not significantly affect the neuropsychiatric development of the children. Nevertheless, the evidence for specific neurodevelopmental disorders and specific antipsychotic drugs remains limited.

Researchers from Australia, Denmark, Finland, Norway, Sweden and Denmark, led by Helga Zoega of the University of New South Wales, conducted the most comprehensive study to date assessing the risks of neurodevelopmental disorders in children following prenatal exposure to different antipsychotics.

The study included data on 212342 children from women with a recorded psychiatric diagnosis. 11626 children were exposed intrauterine to neuroleptics; of these, 2443 were exposed in the second or third trimester only and 4801 were exposed throughout pregnancy. The most common drugs in monotherapy were quetiapine, olanzapine, prochlorperazine, perphenazine, aripiprazole, and levomepromazine. Among the subgroup of children for whom there was evidence of subsequent educational success, 1958 children were intrauterine "treated" with neuroleptics.

Women who took antipsychotic medications during pregnancy were more likely to be older than 35 years, to have lower educational attainment and higher body mass index, to be smokers, and more likely to have taken other medications during pregnancy. The overall cumulative incidence of complex neurodevelopmental disorders diagnosed at age eight years in children with prenatal exposure to antipsychotic medications was four percent, compared with 2.2 percent of control children. Risk estimates for neurodevelopmental disorders were reduced in fully adjusted models, and adjusted odds ratios demonstrated no associations between exposure and outcome.

There was a nonsignificant positive association between any neurodevelopmental disorder and taking antipsychotic medication late in pregnancy, 1.24. Researchers also linked taking chlorpromazine to some risk of neurodevelopmental disorders. Prenatal exposure to neuroleptics was not associated with poor math or native language performance, with fully adjusted risk ratios of 1.04 and 1.00, respectively. Taking levomepromazine was associated with a nonsignificantly increased risk of poor math performance.

Based on the findings, the authors of the article concluded that taking the most common neuroleptics during pregnancy can be considered safe in the long-term development of the child's nervous system.