Antipsychotic Discontinuation and Re-initiation in Pregnant Women With Schizophrenia: A Retrospective Cohort Study From South Korea

Abstract

Background and Hypothesis Pregnant women with schizophrenia are more likely to discontinue treatment, which could trigger a relapse of symptoms. However, data on patterns and risk factors related to antipsychotic discontinuation and re-initiation in Asian pregnant women are insufficient. Study Design We conducted a retrospective cohort study using a nationwide Korean database. The pregnancy group included women who had received antipsychotics before pregnancy and was matched 1:2 with a non-pregnancy group. Using Kaplan–Meier curves, we assessed discontinuation patterns during pregnancy and re-initiation patterns among those who discontinued treatment within the first trimester. A Cox proportional hazards regression analysis was used to examine factors associated with first-trimester discontinuation and re-initiation among those who discontinued during this period. Study Results Pregnant women (n = 2066) had a significantly higher risk of discontinuation than did non-pregnant women (adjusted hazard ratio 3.09; 95% confidence interval 2.85–3.34). Within the first trimester, 67.5% of pregnant women (n = 1394) discontinued antipsychotic use. Women aged 25–29 years were more likely to discontinue (1.25; 1.07–1.47). Among first-trimester discontinuers, 35.2% (n = 491) re-initiated treatment before delivery. A longer duration of antipsychotic use (1.60; 1.06–2.42) and higher daily doses (2.47; 1.76–3.45) were associated with re-initiation of antipsychotics. Conclusions We revealed that most pregnant women discontinued schizophrenia treatment, but those using higher cumulative doses had a higher likelihood of re-initiation. Our findings imply that treatment decisions for pregnant women should consider various clinical factors, including the history of prescriptions and obstetric characteristics. Moreover, these patients require close monitoring after discontinuation.