(A-297) Association of Risk of Congenital Malformations and Neurodevelopmental Disorders in Offspring in Women Who Continued Antipsychotics (APs) During Pregnancy

Background: Exposure to antipsychotics (APs) during the first trimester of pregnancy raises concerns about the risks of congenital malformations (CMs) and neurodevelopmental disorders (NDDs). However, whether to continue or discontinue APs in women who were already using APs at the time of pregnancy remains uncertain.

Objectives: To evaluate the risks of CMs and NDDs in offspring associated with the continuation versus discontinuation of APs in women who were already using APs at the time of pregnancy.

Methods: We included singleton pregnant women from the Taiwan National Health Insurance Research Database (2010–2020). Women were eligible if they had received at least two APs within two years before their last menstrual period. Exclusion criteria were chromosomal abnormalities, and exposure to known teratogens during the first trimester. Patients were classified into two groups: those who continued APs during the first trimester and those who discontinued APs. The primary outcomes included CMs (eleven specific malformation subtypes) and NDDs (seven distinct disorders). Offspring were followed from birth until outcome occurrence, death, or the end of the database (December 31, 2020), whichever came first. Propensity score weighting with fine stratification was applied to adjust for confounding factors, including general and maternal psychiatric comorbidities and co-medications. We used Cox proportional hazards models to estimate hazard ratios (HRs) for NDDs, and logistic regression models to assess risk ratios (RRs) for CMs.

Results: A total of 2,680 and 5,605 women were included in the continuation and discontinuation groups, with mean ages of 33.0 years (SD 5.2) and 31.7 years (SD 5.6), respectively. After fine stratification adjustment, baseline characteristics were comparable between the groups. We found no difference between the two groups in the risk of CMs (RR 1.04; 95% CI 0.92–1.18). However, compared to the discontinuation group, continuation of APs was associated with an increased risk of composite NDDs (HR 1.29; 95% CI 1.15–1.45), mainly driven by developmental speech/language disorders (HR 1.42; 95% CI 1.23–1.64) and developmental coordination disorders (HR 1.48; 95% CI 1.25–1.75).

Conclusions: Our findings suggest that continuing APs during the first trimester in women who were already using APs was not associated with an increased risk of CMs but was associated with an increased risk of NDDs in offspring. Clinicians should carefully weigh the potential risks and benefits of AP continuation in this population.