Association between exposure to atypical antipsychotics during pregnancy and risk of miscarriage

IF 5.3 2区医学 Q1 PSYCHIATRY

Acta Psychiatrica Scandinavica Pub Date : 2024-09-05 DOI:10.1111/acps.13755

Tomofumi Ishikawa, Takamasa Sakai, Noriyuki Iwama, Ryo Obara, Kei Morishita, Motohiko Adomi, Aoi Noda, Mami Ishikuro, Saya Kikuchi, Natsuko Kobayashi, Hiroaki Tomita, Masatoshi Saito, Hidekazu Nishigori, Shinichi Kuriyama, Nariyasu Mano, Taku Obara

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引用次数: 0

Abstract

Objective

To evaluate the association between exposure to atypical antipsychotics during pregnancy and risk of miscarriage.

Material and Methods

This nested case–control study used a large Japanese administrative database. Pregnancy onset and outcomes were estimated using previously reported algorithms, classifying cases as women becoming pregnant between 2013 and 2022 and ending in a miscarriage. Controls were randomly selected from the entire pregnancy cohort by risk-set sampling with replacement and were individually matched to the cases (3:1). The association between exposure to atypical antipsychotics and risk of miscarriage was assessed using conditional logistic regression adjusted for confounders. The association between benzodiazepine exposure and the risk of miscarriage was assessed as a positive control.

Results

In the cohort, 44,118 patients were matched with 132,317 controls. The mean ages (standard deviations) of the case and control groups were 33.3 (5.7) and 33.2 (5.5) years, respectively. The prevalence of atypical antipsychotics was 0.5% in both groups. Aripiprazole is an individual antipsychotic with the highest prescription prevalence. The adjusted odds ratios (aOR) for miscarriage were 0.966 (95% confidence interval [CI], 0.796–1.173) for atypical antipsychotics and 0.998 (0.784–1.269) for aripiprazole. A higher aOR (1.431, 95% CI 1.303–1.573) suggested an association with benzodiazepines. A sensitivity analysis that limited the population to women diagnosed with schizophrenia alone did not suggest an association between atypical antipsychotics and the risk of miscarriage.

Conclusions

The results of this study do not suggest an association between exposure to atypical antipsychotics during pregnancy and the risk of miscarriage.

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孕期接触非典型抗精神病药物与流产风险之间的关系。

目的：评估孕期接触非典型抗精神病药物与流产风险之间的关系：评估孕期接触非典型抗精神病药物与流产风险之间的关系：这项巢式病例对照研究使用了日本的大型行政数据库。妊娠起始时间和妊娠结局采用之前报道过的算法进行估计，将病例归类为在 2013 年至 2022 年期间怀孕并最终流产的女性。对照组是通过风险设置抽样从整个怀孕队列中随机抽取的，并与病例进行单独配对（3:1）。非典型抗精神病药物暴露与流产风险之间的关系采用条件逻辑回归进行评估，并对混杂因素进行了调整。苯二氮卓类药物暴露与流产风险之间的关系作为阳性对照进行评估：在队列中，44 118 名患者与 132 317 名对照者进行了配对。病例组和对照组的平均年龄（标准差）分别为 33.3（5.7）岁和 33.2（5.5）岁。两组中使用非典型抗精神病药物的比例均为 0.5%。阿立哌唑是处方率最高的一种抗精神病药物。非典型抗精神病药物的调整后流产几率（aOR）为0.966（95%置信区间[CI]，0.796-1.173），阿立哌唑的调整后流产几率（aOR）为0.998（0.784-1.269）。较高的 aOR（1.431，95% CI 1.303-1.573）表明与苯二氮卓类药物有关。一项敏感性分析将研究对象限定为仅诊断出患有精神分裂症的女性，但该分析并未显示非典型抗精神病药物与流产风险之间存在关联：本研究的结果并不表明孕期接触非典型抗精神病药物与流产风险之间存在关联。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Acta Psychiatrica Scandinavica 医学-精神病学

CiteScore

11.20

自引率

3.00%

发文量

135

审稿时长

6-12 weeks

期刊介绍： Acta Psychiatrica Scandinavica acts as an international forum for the dissemination of information advancing the science and practice of psychiatry. In particular we focus on communicating frontline research to clinical psychiatrists and psychiatric researchers. Acta Psychiatrica Scandinavica has traditionally been and remains a journal focusing predominantly on clinical psychiatry, but translational psychiatry is a topic of growing importance to our readers. Therefore, the journal welcomes submission of manuscripts based on both clinical- and more translational (e.g. preclinical and epidemiological) research. When preparing manuscripts based on translational studies for submission to Acta Psychiatrica Scandinavica, the authors should place emphasis on the clinical significance of the research question and the findings. Manuscripts based solely on preclinical research (e.g. animal models) are normally not considered for publication in the Journal.