Table 3.
Secondary maternal and perinatal outcomes in a cohort of 41 523 women who were categorised by whether they were prescribed an antipsychotic drug during pregnancy (n=1209) or not (n=40 314). Of these, 1021 antipsychotic drug users were matched 1:1 with 1021 non-users by means of a high dimensional propensity score (HDPS) algorithm
| Outcome and use of antipsychotic medication | Unmatched cohort | Matched cohort | ||||
|---|---|---|---|---|---|---|
| No (%) with outcome | Relative risk (95% CI) | No (%) with outcome | Relative risk (95% CI) | Adjusted relative risk (95% CI)* | ||
| Obstetric conditions and complications† | ||||||
| Placental abruption: | ||||||
| Non-users | 640 (1.6) | 1.00 (referent) | 16 (1.6) | 1.00 (referent) | 1.00 (referent) | |
| Antipsychotic users | 37 (3.1) | 1.93 (1.38 to 2.69) | 28 (2.7) | 1.75 (0.95 to 3.23) | 2.06 (0.98 to 4.28) | |
| Placental infarction: | ||||||
| Non-users | 220 (0.6) | 1.00 (referent) | 9 (0.9) | NR | NR | |
| Antipsychotic users | ≤5 | NR | ≤5 | NR | NR | |
| Septic shock: | ||||||
| Non-users | 170 (0.4) | 1.00 (referent) | ≤5 | NR | NR | |
| Antipsychotic users | 7 (0.6) | 1.38 (0.65 to 2.93) | 6 (0.6) | NR | NR | |
| Peripartum haemorrhage: | ||||||
| Non-users | 1915 (4.8) | 1.00 (referent) | 54 (5.3) | 1.00 (referent) | 1.00 (referent) | |
| Antipsychotic users | 69 (5.7) | 1.20 (0.95 to 1.53) | 54 (5.3) | 1.00 (0.69 to 1.46) | 0.98 (0.64 to 1.49) | |
| Labour and delivery | ||||||
| Labour induction: | ||||||
| Non-users | 9343 (23.2) | 1.00 (referent) | 235 (23.0) | 1.00 (referent) | 1.00 (referent) | |
| Antipsychotic users | 339 (28.0) | 1.21 (1.09 to 1.35) | 282 (27.6) | 1.20 (1.01 to 1.43) | 1.23 (1.03 to 1.48) | |
| Caesarean section: | ||||||
| Non-users | 10670 (26.5) | 1.00 (referent) | 325 (31.8) | 1.00 (referent) | 1.00 (referent) | |
| Antipsychotic users | 388 (32.1) | 1.21 (1.10 to 1.34) | 317 (31.1) | 0.98 (0.84 to 1.14) | 0.97 (0.82 to 1.13) | |
| Operative vaginal delivery: | ||||||
| Non-users | 2590 (6.4) | 1.00 (referent) | 63 (6.2) | 1.00 (referent) | 1.00 (referent) | |
| Antipsychotic users | 112 (9.3) | 1.44 (1.19 to 1.74) | 96 (9.4) | 1.52 (1.11 to 2.09) | 1.55 (1.10 to 2.19) | |
| Major perineal trauma (3rd or 4th degree tear): | ||||||
| Non-users | 1918 (4.8) | 1.00 (referent) | 53 (5.2) | 1.00 (referent) | 1.00 (referent) | |
| Antipsychotic users | 64 (5.3) | 1.11 (0.87 to 1.43) | 59 (5.8) | 1.11 (0.77 to 1.61) | 1.05 (0.71 to 1.57) | |
| Transfer to intensive care unit: | ||||||
| Non-users | 138 (0.3) | 1.00 (referent) | ≤5 | NR | NR | |
| Antipsychotic users | 7 (0.6) | 1.69 (0.79 to 3.61) | ≤5 | NR | NR | |
| Maternal postpartum readmission to hospital | ||||||
| Any readmission (≤7 days): | ||||||
| Non-users | 385 (1.0) | 1.00 (referent) | 27 (2.6) | 1.00 (referent) | 1.00 (referent) | |
| Antipsychotic users | 32 (2.7) | 2.77 (1.93 to 3.98) | 20 (2.0) | 0.74 (0.42 to 1.32) | 0.89 (0.46 to 1.73) | |
| Any readmission (1–12 weeks): | ||||||
| Non-users | 644 (1.6) | 1.00 (referent) | 37 (3.6) | 1.00 (referent) | 1.00 (referent) | |
| Antipsychotic users | 55 (4.6) | 2.85 (2.16 to 3.75) | 43 (4.2) | 1.16 (0.75 to 1.80) | 1.03 (0.64 to 1.65) | |
| Non-mental health (≤7 days): | ||||||
| Non-users | 359 (0.9) | 1.00 (referent) | 19 (1.9) | 1.00 (referent) | 1.00 (referent) | |
| Antipsychotic users | 15 (1.2) | 1.40 (0.83 to 2.34) | 12 (1.2) | 0.63 (0.30 to 1.30) | 0.74 (0.33 to 1.66) | |
| Non-mental health (1–12 weeks): | ||||||
| Non-users | 552 (1.4) | 1.00 (referent) | 22 (2.2) | 1.00 (referent) | 1.00 (referent) | |
| Antipsychotic users | 24 (2.0) | 1.45 (0.96 to 2.18) | 20 (2.0) | 0.91 (0.50 to 1.67) | 0.78 (0.40 to 1.54) | |
| Mental health (≤7 days): | ||||||
| Non-users | 26 (0.1) | 1.00 (referent) | 8 (0.8) | 1.00 (referent) | NR | |
| Antipsychotic users | 17 (1.4) | 21.8 (11.8 to 40.2) | 8 (0.8) | 1.00 (0.38 to 2.66) | NR | |
| Mental health (1–12 weeks): | ||||||
| Non-users | 92 (0.2) | 1.00 (referent) | 15 (1.5) | 1.00 (referent) | 1.00 (referent) | |
| Antipsychotic users | 31 (2.6) | 11.2 (7.48 to 16.9) | 23 (2.3) | 1.53 (0.80 to 2.94) | 1.35 (0.66 to 2.79) | |
| Perinatal indicators | ||||||
| Preterm birth <32 weeks gestation: | ||||||
| Non-users | 991 (2.5) | 1.00 (referent) | 44 (4.3) | 1.00 (referent) | 1.00 (referent) | |
| Antipsychotic users | 47 (3.9) | 1.61 (1.19 to 2.16) | 39 (3.8) | 0.89 (0.58 to 1.36) | 0.85 (0.53 to 1.36) | |
| Preterm birth <28 weeks gestation: | ||||||
| Non-users | 667 (1.7) | 1.00 (referent) | 34 (3.3) | 1.00 (referent) | 1.00 (referent) | |
| Antipsychotic users | 24 (2.0) | 1.20 (0.80 to 1.82) | 20 (2.0) | 0.59 (0.34 to 1.02) | 0.48 (0.25 to 0.93) | |
| Small for gestational age <10th centile: | ||||||
| Non-users | 6307 (15.8) | 1.00 (referent) | 179 (17.9) | 1.00 (referent) | 1.00 (referent) | |
| Antipsychotic users | 239 (20.0) | 1.33 (1.15 to 1.54) | 206 (20.4) | 1.14 (0.93 to 1.40) | 1.20 (0.97 to 1.50) | |
| Large for gestational age >90th centile: | ||||||
| Non-users | 3091 (7.8) | 1.00 (referent) | 77 (7.7) | 1.00 (referent) | 1.00 (referent) | |
| Antipsychotic users | 108 (9.0) | 1.18 (0.97 to 1.45) | 88 (8.7) | 1.15 (0.84 to 1.56) | 1.07 (0.76 to 1.51) | |
| Neonatal complications | ||||||
| Respiratory distress syndrome: | ||||||
| Non-users | 597 (1.5) | 1.00 (referent) | 30 (2.9) | 1.00 (referent) | 1.00 (referent) | |
| Antipsychotic users | 33 (2.7) | 1.87 (1.31 to 2.66) | 26 (2.6) | 0.87 (0.51 to 1.47) | 0.82 (0.46 to 1.43) | |
| Seizure: | ||||||
| Non-users | 78 (0.2) | 1.00 (referent) | 7 (0.7) | 1.00 (referent) | NR | |
| Antipsychotic users | 10 (0.8) | 4.30 (2.22 to 8.33) | 9 (0.9) | 1.29 (0.48 to 3.45) | NR | |
| Sepsis: | ||||||
| Non-users | 419 (1.0) | 1.00 (referent) | 14 (1.4) | 1.00 (referent) | 1.00 (Referent) | |
| Antipsychotic users | 28 (2.2) | 2.26 (1.53 to 3.32) | 24 (2.4) | 1.71 (0.89 to 3.31) | 1.80 (0.84 to 3.85) | |
| Intraventricular haemorrhage: | ||||||
| Non-users | 130 (0.3) | 1.00 (referent) | 6 (0.6) | 1.00 (referent) | NR | |
| Antipsychotic users | 11 (0.9) | 2.84 (1.53 to 5.27) | 8 (0.8) | 1.33 (0.46 to 3.84) | NR | |
| Persistent fetal circulation: | ||||||
| Non-users | 74 (0.2) | NR | ≤5 | NR | NR | |
| Antipsychotic users | ≤5 | NR | ≤5 | NR | NR | |
| Neonatal adaptation syndrome: | ||||||
| Non-users | 858 (2.1) | 1.00 (referent) | 111 (10.9) | 1.00 (referent) | 1.00 (referent) | |
| Antipsychotic users | 161 (13.3) | 7.06 (5.91 to 8.45) | 132 (12.9) | 1.19 (0.92 to 1.53) | 1.15 (0.88 to 1.50) | |
| Congenital or neonatal infection: | ||||||
| Non-users | 145 (0.4) | 1.00 (referent) | 10 (1.0) | 1.00 (referent) | NR | |
| Antipsychotic users | 7 (0.6) | 1.61 (0.75 to 3.45) | 7 (0.7) | 0.70 (0.27 to 1.84) | NR | |
| Congenital malformations: | ||||||
| Non-users | 1589 (4.0) | 1.00 (referent) | 40 (4.0) | 1.00 (referent) | 1.00 (referent) | |
| Antipsychotic users | 50 (4.2) | 1.05 (0.79 to 1.41) | 44 (4.4) | 1.10 (0.72 to 1.69) | 1.19 (0.75 to 1.91) | |
| Maternal and perinatal mortality | ||||||
| Stillbirth >20 weeks gestation: | ||||||
| Non-users | 349 (09) | 1.00 (referent) | 16 (1.6) | 1.00 (referent) | NR | |
| Antipsychotic users | 12 (1.0) | 1.15 (0.64 to 2.05) | 9 (0.9) | 0.56 (0.25 to 1.27) | NR | |
| Neonatal mortality <90 days: | ||||||
| Non-users | 184 (0.5) | 1.00 (referent) | 6 (0.6) | 1.00 (referent) | NR | |
| Antipsychotic users | 9 (0.7) | 1.64 (0.84 to 3.20) | 9 (0.9) | 1.50 (0.53 to 4.21) | NR | |
| Maternal mortality 0–90 days postpartum: | ||||||
| Non-users | 9 (0.0) | NR | 0 (0.0) | NR | NR | |
| Antipsychotic users | ≤5 | NR | ≤5 | NR | NR | |
*Adjusted for a prescribed selective serotonin reuptake inhibitor (SSRI), non-SSRI, mood stabiliser, or benzodiazepine during the index pregnancy.
†No outcomes were observed in either study group for other conditions that included cardiomyopathy, acute renal failure, cerebrovascular disease, acute respiratory distress syndrome, disseminated intravascular coagulation, or status epilepticus
NR=Not reportable because of counts ≤5 or non-convergence of the adjusted model.