Prenatal publicity to antipsychotic medicine doesn’t enhance odds of autism, ADHD | Spectrum
Continuing treatment: The evidence does not support discontinuation of antipsychotics during pregnancy.
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Children of mothers who take antipsychotic medications during pregnancy are not at increased risk of developing autism or attention deficit hyperactivity disorder (ADHD), nor are they more likely to be born prematurely or underweight, according to a study published in JAMA Internal Medicine last Monday.
Some women with schizophrenia, Tourette’s syndrome, or bipolar disorder take antipsychotics such as aripiprazole, haloperidol, or risperidone. Clinicians have long debated whether women should discontinue these drugs during pregnancy out of concern about the effects of the drugs on the developing fetus.
But children born to mothers who take antipsychotics during pregnancy and those who do not have similar results, the new work shows.
“Our results do not support a recommendation for women to discontinue their regular antipsychotic treatment during pregnancy,” says lead researcher Kenneth Man, a research fellow at University College London School of Pharmacy in the UK.
Prescribing antipsychotics during pregnancy can help prevent potentially dangerous psychotic episodes and ensure an expectant mother can fend for herself, says Mady Hornig, an adjunct professor of epidemiology at Columbia University who was not involved in the study . “We certainly don’t want to be rash about taking medication during pregnancy, but we also want to weigh the effects of not treating it.”
Any apparent effects of antipsychotics on a developing fetus are likely due to the condition being treated rather than the treatment, the study shows. New research on the relationship between prenatal antidepressant exposure and autism in children comes to a similar conclusion.
Man and his colleagues used public health data on 411,251 children born over 15 years in Hong Kong public hospitals and clinics, as well as follow-up data on those children for 3 years and data on their mothers’ medical history and medication. They looked for associations with autism, ADHD, premature birth, and low gestational weight.
An initial analysis linked prenatal antipsychotics to a small increase in premature births, but this association disappeared after further statistical analysis to rule out an effect known as indication confounding: doctors prescribe drugs for a reason – or an indication – that lead to additional ones can be differences between people and biased study results.
“If we naively compare the effects of the medication between the treated and the untreated, without adequately taking into account the differences between the groups,” says Man, “the results are skewed by these differences.”
To address this possibility, the team divided part of the study population into groups, including those with psychiatric conditions who had or never used antipsychotics, including mothers who continued to take them during pregnancy and those who took the medication took but stopped when she became pregnant.
Initial analyzes showed that the mothers in this last group had, on average, children with a higher incidence of ADHD, premature births, and low birth weights. However, since the infants were never exposed to antipsychotics, the result suggested confusion by indication.
Comparisons with siblings came to a similar conclusion: mothers with existing psychiatric illnesses are more likely to have children with autism or ADHD, but not premature babies or underweight children, regardless of whether they take antipsychotics during pregnancy.
“The sibling design is a really nice design, and the negative comparator groups were a really nice design,” says Hornig.
These methods helped address potential differences in the study population that made it more likely that a person would be in the exposed group, she says, but adds that it would have been helpful if the researchers further subdivided the mothers with psychiatric illnesses according to their condition and medication. Additionally, a longer study follow-up could have ensured that all children with autism were accurately tracked and that all ADHD diagnoses – a notoriously unstable diagnosis in young children – were actually confirmed, says Hornig.
Stratifying according to a specific drug would have been difficult because few mothers in the sample were prescribed antipsychotics, which limits the statistical power of such an analysis, says Man.