(A-296) Risk of Psychiatric Relapse After First-Trimester Antipsychotic Discontinuation in Pregnant Women with Schizophrenia

Background: Medication discontinuation in the first trimester is frequently observed among pregnant women with schizophrenia. However, the evidence regarding its association with the worsening of symptoms or relapse remains limited.

Objective: To evaluate the association between first-trimester antipsychotic discontinuation and subsequent relapse in pregnant women with schizophrenia.

Methods: Using the 2011–2020 Health Insurance Review and Assessment Service database in Korea, we constructed a cohort of pregnant women aged 15–49 years with schizophrenia. Women with emergency room visits or hospital admissions for psychiatric conditions, or diagnoses related to self-harm or suicide before the second trimester were excluded. Those who discontinued antipsychotics from 90 days before pregnancy through the first trimester were classified as the discontinuation group, while those who continued treatment comprised the continuation group. The primary outcome was a composite of emergency room visits for psychiatric conditions, psychiatric hospital admissions, or self-harm or suicide attempts. Secondary outcomes included psychiatric emergency room visits and hospital admissions, evaluated separately. Patients were followed from the second trimester until 90 days postpartum or the occurrence of the event, whichever came first. To balance covariates, the stabilized inverse probability of treatment weights were calculated using the propensity score. A weighted Cox proportional hazards model was used to estimate adjusted hazard ratios (aHR) and 95% confidence intervals (CI).

Results: A total of 1,790 delivery episodes from 1,685 women were included, with 1,205 episodes in the discontinuation group and 585 episodes in the continuation group. The incidence rates (IRs) of the primary outcome were 240.0 per 1,000 person-years (95% CI, 239.1–241.0) in the discontinuation group and 124.1 per 1,000 person-years (95% CI, 122.7–125.6) in the continuation group. The aHR for the primary outcome was 2.06 (95% CI, 1.51–2.82) in the discontinuation group compared with the continuation group. The aHRs were 2.19 (95% CI, 1.38–3.46) for psychiatric emergency room visits and 2.06 (95% CI, 1.48–2.88) for psychiatric hospital admissions.

Conclusions: Our findings suggest a higher risk of subsequent psychiatric relapse in pregnant women who discontinued treatment within the first trimester. Further investigation is required to assess the long-term impact of treatment discontinuation during pregnancy.