番茄社区

NEW YORK -- Continuation of certain antipsychotics with weight-gain risk throughout pregnancy was tied to an elevated risk of gestational diabetes, researchers reported here.

Continuing on quetiapine (relative risk 1.28, 95% CI 1.01 to 1.62) or olanzapine (RR 1.61, 95% CI 1.13 to 2.29) was defined as two or more dispenses during the first 140 days of pregnancy, according to the study by Yoonyoung Park, ScD, of Brigham & Women's Hospital in Boston, and colleagues.

However, pregnant women who continued on other atypical antipsychotics did not show any significant increased risk for gestational diabetes in an adjusted model:

• Aripiprazole: RR 0.82 (95% CI 0.50 to 1.33)
• Ziprasidone: RR 0.76 (95% CI 0.29 to 2.00)
• Risperidone: RR 1.09 (95% CI 0.70 to 1.70)

The findings were presented at the annual meeting of the American Psychiatric Association and published simultaneously online in the .

Park told 番茄社区 that the team wasn't particularly surprised to discover that olanzapine (Zyprexa) was tied to the highest risk for gestational diabetes out of all the antipsychotics measured, since that drug's association with weight gain is well recognized. That's been an issue for quetiapine (Seroquel) as well.

The study analysis included a total of 1,543,334 pregnancies in mothers without diabetes enrolled in Medicaid. All were administered at least one prescription dispensed for an antipsychotic drug within the 3 months prior to pregnancy. Among the cohort, the most common antipsychotic drug the individuals were treated with was quetiapine (n=4,533), followed by aripiprazole (n=1,924), risperidone (n=1,824), olanzapine (n=1,425), and ziprasidone (n=673).

Fewer women continued on medication through pregnancy -- accounting for 19.7% to 34.0% of pregnancies included -- compared with those who discontinued. Those who continued on medication through pregnancy tended to be older and had slightly more use of other psychotropic treatments.

Compared with women who discontinued medication, those who continued had a wider absolute risk range for gestational diabetes (4.2%-12.0% versus 3.8%-4.7%).

A dose-response subanalysis showed that a higher cumulative dose of olanzapine was associated with a rising increased risk for gestational diabetes. This dose-dependent relationship, not seen with other antipsychotics, was seen until the cumulative dose reached approximately 700 mg, after which it then plateaued.

One limitation to the study, which may have confounded the findings, Park and colleagues noted, was a lack of data regarding obesity status and other lifestyle factors, along with the severity of psychiatric illness and the indication for the specific antipsychotic medication used.

Park recommended that patients and providers maintain an open dialogue when it comes to continuing, discontinuing, or even switching treatment during pregnancy. "For women who are already on high-risk antipsychotics, such as olanzapine, it may be worth having a conversation about potentially switching or discontinuing medication with their psychiatrists or physicians, carefully weighing the risk of adverse events with the benefit of continuing the treatment and maintaining the treatment efficacy."

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