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Antipsychotic utilization patterns in pregnant women with psychotic disorders: a 16-year population-based cohort study

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Abstract

Despite growing concern about reproductive safety of antipsychotics, there is a paucity of research specifically assessing prenatal antipsychotic prescribing practices for psychotic disorders. This population-based cohort study identified women aged 15–50 years with diagnosis of psychotic disorders, who delivered their first and singleton child between 2003–2018 in Hong Kong, with an aim to examine temporal trends and predictors of prenatal antipsychotic use as well as antipsychotic utilization patterns before and during pregnancy. Data were retrieved from territory-wide medical-record database of public healthcare services. Of 804 women, 519 (65%) redeemed at least one prescription for antipsychotics during pregnancy. Older age at conception (25–34 years: OR 2.12 [95% CI 1.22–3.67]; 35–50 years: 2.52 [1.38–4.61]; 15–24 years as reference category) and antipsychotic treatment within 12 months pre-pregnancy (24.22 [16.23–36.16]) were significantly associated with prenatal antipsychotic use. Second-generation-antipsychotic (SGA) use during pregnancy increased over 16-year study period, while prenatal first-generation-antipsychotic (FGA) use showed declining trend. Overall antipsychotic and SGA use progressively decreased across pre-pregnancy and trimesters of pregnancy. Further analyses on antipsychotic use trajectories revealed that 87.4% (n = 459) of 529 women receiving antipsychotics in 12-month pre-pregnancy redeemed antipsychotic prescription during pregnancy, and 63.4% (n = 333) continued antipsychotic treatment throughout pregnancy. Only 7.5% of the cohort (n = 60) commenced antipsychotics in pregnancy. This is one of the few studies evaluating real-world prenatal antipsychotic utilization among women with psychotic disorders. Future research delineating risk conferred by illness-related factors and antipsychotic exposure on adverse maternal and fetal outcomes is warranted to facilitate treatment guideline development.

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Acknowledgements

The study was supported by the Hong Kong Research Grants Council (grant number: 17127417). Additional financial support to undertake this research was provided by the State Key Laboratory of Brain & Cognitive Sciences, the University of Hong Kong. The authors would like to thank the colleagues in Hospital Authority for their kind assistance in data retrieval for the current investigation.

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  1. Jenny Wai Yiu Law and Joe Kwun Nam Chan contributed equally to the article (as co-first authors).

Authors and Affiliations

  1. Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China

    Jenny Wai Yiu Law, Joe Kwun Nam Chan, Corine Sau Man Wong, Eric Yu Hai Chen & Wing Chung Chang

  2. State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, China

    Eric Yu Hai Chen & Wing Chung Chang

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  1. Jenny Wai Yiu Law
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Contributions

Authors WCC, CSMW and JKNC designed and conceptualized the study. Author JWYL and JKNC conducted statistical analysis and wrote the first draft of the manuscript. Authors WCC, JWYL, JKNC, and CSMW interpreted the study data. Author WCC revised and finalized the manuscript. All authors provided critical feedback to the manuscript and have approved the final manuscript.

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Correspondence to Wing Chung Chang.

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Law, J.W.Y., Chan, J.K.N., Wong, C.S.M. et al. Antipsychotic utilization patterns in pregnant women with psychotic disorders: a 16-year population-based cohort study. Eur Arch Psychiatry Clin Neurosci 273, 901–909 (2023). https://doi.org/10.1007/s00406-022-01453-1

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  • DOI: https://doi.org/10.1007/s00406-022-01453-1

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