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Invited Commentary
August 16, 2021

Continuation of Antipsychotic Treatment in Pregnancy—Do Not Panic

Author Affiliations
  • 1Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco
  • 2Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
JAMA Intern Med. 2021;181(10):1341-1342. doi:10.1001/jamainternmed.2021.4562

In this issue of JAMA Internal Medicine, Wang and colleagues1 examine the risk of adverse obstetric and child neurodevelopmental outcomes following prenatal exposure to antipsychotic medications. This large population-based retrospective cohort study evaluated the risks of attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), preterm birth, and small for gestational age for children born between 2001 and 2015 with follow-up to 2019. Their analysis of pregnancies with prenatal exposure to antipsychotics did not suggest that these medications increased the risk for ADHD, ASD, or small for gestational age compared with unexposed pregnancies. While their primary analysis showed a small increased risk of preterm birth, additional analyses comparing gestationally exposed individuals with those with a past exposure and gestationally exposed with gestationally nonexposed siblings did not suggest an increased risk. Notably, offspring of mothers with a psychiatric diagnosis who had never filled prescriptions for antipsychotics did show a significantly increased risk of ADHD and ASD compared with offspring of mothers without a psychiatric diagnosis, but there was no difference in preterm birth or small for gestational age. These data support the growing evidence that antipsychotics are not major neurodevelopmental teratogens and can provide reassurance to mothers with psychiatric illness and their clinicians that these medications may be continued or initiated if needed during pregnancy.2 Additionally, these findings support the hypothesis that underlying maternal psychiatric illness and associated factors that cluster with these diagnoses have a larger association with neurodevelopmental outcomes than in utero antipsychotic medication exposures.

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