(T) Association Between Prenatal Antipsychotic Exposure and The Risk of Attention-Deficit/Hyperactivity Disorder and Autism Spectrum Disorder: A Systematic Review and Meta-Analysis

Sunday, August 28, 2022

8:00 AM – 6:00 PM CEST

Location: Hall E South

Publication Number: 1019

Presenting Author(s)

Zixuan WANG
– Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom

Co-Author(s)

Kirstie Wong
– University of Hong Kong, United Kingdom
Ian Wong
– Professor, Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China, Hong Kong
Kenneth Man, PhD
– Lecturer in Pharmacoepidemiology and Medication Safety, University of Hong Kong, London, United Kingdom

Background: The risk of attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) in children with prenatal antipsychotic exposure is unclear.

Objectives: To evaluate whether prenatal exposure to antipsychotics is at increased risk of ADHD and ASD in children.

Methods: A systematic literature search was conducted in PubMed, EMBASE, APA PsycINFO and Cochrane Library databases up to March 29, 2022, for data from observational studies assessing the association between prenatal antipsychotic use and ADHD/ASD in children. Non-English studies, animal studies, case reports/series, cross-sectional studies, conference abstracts, book chapters, reviews and summaries were excluded. The primary outcome was ADHD/ASD reported with prenatal antipsychotic use. The Newcastle–Ottawa Scale (NOS) was used to assess the methodological quality of included studies. Estimates were pooled using a random effect model, with the I2 statistic used to estimate heterogeneity of results.

Results: In total, six studies fulfilled our systematic review inclusion criteria with more than 8.6 million pregnancy episodes in nine different countries/regions. Three studies were included in the primary meta-analysis for ADHD or ASD, which provided a pooled adjusted relative risk (aRR) of 1.11 (95% confidence interval [CI]: 1.03-1.19, I2=0.0%, p=0.956) for ADHD and 1.10 (95% CI: 0.98-1.24, I2=0.0%, p=0.930) for ASD. However, when compared past exposed with never exposed, the pooled aRRs for ADHD and ASD were 1.96 (95% CI: 1.05-3.66, I2=95.8%, p=0.000) and 1.38 (95% CI: 1.20-1.60, I2=0.0%, p=0.890), respectively. The pooled aRRs for sibling-matched analyses were 1.11 (95% CI: 0.78-1.60, I2=0.0%, p=0.410) for ADHD and 1.17 (95% CI: 0.73-1.87, I2=0.0%, p=0.432) for ASD.

Conclusions: The findings did not suggest a causal relationship for the risk of ADHD or ASD with maternal prenatal antipsychotic exposures. Women should discuss their individual cases with clinicians to decide whether use of antipsychotic in pregnancy is indicated and that potential benefits outweigh the risks.