The use of the newer “atypical” or second-generation antipsychotic (SGA) agents continues to increase.  These medications are used to treat a spectrum of psychiatric disorders, including schizophrenia, bipolar disorder, major depression, PTSD and anxiety disorders.  Although most of the women taking atypical antipsychotics are of childbearing age, our information on the reproductive safety of these newer atypical agents lags behind.

Last year we reported on findings drawn from the National Pregnancy Registry for Atypical Antipsychotics showing that prenatal exposure to atypical antipsychotics did not meaningfully increase risk for congenital malformations.  While these data are certainly reassuring and will clearly help women make decisions regarding the use of these medications during pregnancy, other questions regarding their reproductive safety of second-generation antipsychotics remain.  

One of the concerns we have had regarding the use of the newer antipsychotic medications during pregnancy is that these medications may render women more vulnerable to gestational weight gain and/or diabetes, a concern stemming from the finding of weight gain and  increased rates of diabetes in non-pregnant patients taking atypical antipsychotics.  Using data from the National Pregnancy Registry for Atypical Antipsychotics, Dr. Marlene Freeman and colleagues examined gestational weight gain in women taking atypical antipsychotics.

The analysis included 403 women followed during pregnancy (N=279 exposed to SGAs; N=124 unexposed controls). The two groups differed on several important variables; women taking SGAs were more likely to have a higher mean pre-pregnancy weight and body mass index (BMI) and were more likely to begin pregnancy with an obese BMI.  The mean weight gain did not differ significantly between groups.  Both groups gained more than the recommended amount of weight during pregnancy.This study did not assess risk for gestational diabetes.  

This study indicates that the use of SGAs was not associated with increased weight gain as exposed and unexposed women experienced similar weight gain during pregnancy. While use of SGAs may not pose significant risk during pregnancy, women taking SGAs enter into pregnancy with higher BMIs than women not taking SGAs.  

However, obesity and metabolic dysregulation have profound implications for women of reproductive age.  Obesity during pregnancy increases the risk of adverse maternal and neonatal outcomes, including major birth defects, prematurity, and other obstetrical risks that could have long-lasting consequences for offspring.  Thus, it is extremely important to develop strategies both before and during pregnancy for women of reproductive age to prevent the weight gain that is commonly associated with the use of second-generation antipsychotics.  

Ruta Nonacs, MD PhD

Freeman MP, Sosinsky AZ, Goez-Mogollon L, Savella GM, Moustafa D, Viguera AC, Cohen LS.  Gestational Weight Gain and Pre-pregnancy Body Mass Index Associated With Second-Generation Antipsychotic Drug Use During Pregnancy.   Psychosomatics. 2017 Sep 21.

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