Antipsychotics and antidepressants in pregnancy linked to higher gestational diabetes risk

Design

Systematic review and meta-analysis of observational studies

Population

21 studies of pregnant women exposed to antipsychotics or antidepressants

Primary outcome

Gestational diabetes

Effect

Antipsychotics RR 1.43 (1.17–1.69); antidepressants RR 1.19 (1.10–1.27); SGAs RR 1.6 (1.23–1.97)

This meta-analysis pooled 21 observational studies of women exposed to antipsychotics or antidepressants in pregnancy. The pooled adjusted relative risk of gestational diabetes was 1.43 (95% CI 1.17–1.69) with antipsychotics and 1.19 (1.10–1.27) with antidepressants. Second-generation antipsychotics carried the highest estimate, RR 1.6 (1.23–1.97); first-generation drugs showed no significant association.

These are associations. Women who need these drugs differ from those who do not, in weight, activity, smoking and the illness itself, and adjustment in the source studies will not have captured all of it. The direction fits what is known about second-generation antipsychotics and weight and insulin resistance outside pregnancy.

The useful response is surveillance rather than withdrawal. Stopping effective psychiatric treatment in pregnancy carries its own risks, and this study cannot weigh them.

• Consider early glucose testing in pregnant women taking second-generation antipsychotics, rather than waiting for routine 24–28 week screening.
• Record psychotropic exposure in the antenatal booking history so it informs GDM risk assessment.
• Do not stop an effective antipsychotic or antidepressant in pregnancy on metabolic grounds alone; discuss with the psychiatrist.
• Weight gain and baseline BMI in these women are worth tracking at each antenatal visit.

Why it matters

Psychotropic use is a gestational diabetes risk factor most screening checklists do not ask about.

Don't overread it

Observational data: this cannot show the drugs cause gestational diabetes, or that switching drugs would prevent it.

The statistics, in plain English

A relative risk of 1.43 means about 43% higher risk than in unexposed women; whether that matters depends on the baseline risk, which is high in India. Neither confidence interval crosses 1.0, so chance alone is an unlikely explanation, but confounding remains possible in observational data.

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