Second-generation antipsychotics linked to more gestational diabetes

Design

Systematic review and random-effects meta-analysis of observational studies

Population

21 studies of pregnant women with or without antidepressant or antipsychotic exposure

Primary outcome

Gestational diabetes

Effect

Antipsychotics RR 1.43 (1.17 to 1.69); antidepressants RR 1.19 (1.10 to 1.27); second-generation antipsychotics RR 1.6 (1.23 to 1.97)

This systematic review pooled 21 observational studies, searched to June 2025, that reported gestational diabetes after antidepressant or antipsychotic exposure in pregnancy. Pooled adjusted relative risks were 1.43 (95% CI 1.17 to 1.69) for any antipsychotic and 1.19 (1.10 to 1.27) for antidepressants. Second-generation antipsychotics drove the antipsychotic signal, with an RR of 1.6 (1.23 to 1.97); first-generation agents showed no significant association.

The finding fits what is known about the metabolic effects of drugs such as olanzapine and quetiapine outside pregnancy. It moves the question from whether these women need closer glucose surveillance to how it is organised, because severe mental illness, obesity and smoking cluster in this group and each raises gestational diabetes risk on its own.

The practical response is screening, not withdrawal. Untreated severe mental illness in pregnancy carries its own serious risks, and stopping an effective antipsychotic or antidepressant to avoid a modest rise in glucose risk is rarely the right trade. Flag exposed women at booking and make sure glucose testing happens on time.

• Ask about antipsychotic and antidepressant use at booking and record the specific drug.
• Treat second-generation antipsychotic use as a gestational diabetes risk factor when planning glucose testing.
• Consider early glucose testing in women on second-generation antipsychotics who also have obesity or a family history of diabetes.
• Do not stop an effective psychotropic for this reason alone; discuss any change with the treating psychiatrist.
• Check weight gain and glucose again in the third trimester if the first test was normal.

Why it matters

Psychotropic use belongs in the gestational diabetes risk assessment, not only in the mental health history.

Don't overread it

Observational data cannot show the drugs cause diabetes; the illness and its associated weight gain may account for part of it.

The statistics, in plain English

An RR of 1.6 means about 60% more gestational diabetes in exposed women than unexposed; all three intervals sit above 1.0, so chance alone is an unlikely explanation. But these are observational studies, and women prescribed these drugs differ from those who are not in weight, diet and illness severity, which adjustment cannot fully remove.

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