Oral Presentation
Medications in Pregnancy & Lactation (MiPaL)
Claudia Bruno, BSc(hon) (she/her/hers)
PhD candidate
School of Population Health, University of New South Wales; Department of Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway
Sydney, United States
Carolyn E. Cesta, PhD
Researcher
Centre for Pharmacoepidemiology, Karolinska Institutet
Stockholm, Sweden
Vidar Hjellvik, PhD
Statistician
Norwegian Institute of Public Health, Norway
Sinna Pilgaard Ulrichsen, MSc (she/her/hers)
Biostatistician
Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark, Denmark
Marte-Helene h. Bjørk, MD, PhD
Professor, consultant neurologist
NorHEAD Norwegian Centre for Headache Research, Department of Clinical Medicine, University of Bergen, Bergen, Norway Jonas Lies vei 87 5021, Bergen Norway
Bergen, Hordaland, Norway
Buket Öztürk Esen, MSc
PhD candidate
Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
Aarhus N, Midtjylland, United States
Malcolm B. Gillies, PhD (he/him/his)
Senior Biostatistician
School of Population Health, University of New South Wales, Australia
Mika Gissler, PhD
Professor
Department of Knowledge Brokers, Finnish Institute for Health and Welfare, Helsinki, Finland
Alys Havard, PhD (she/her/hers)
Senior Research Fellow
National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia, Australia
Pär Karlsson, MSc (he/him/his)
Statistician
Centre for Pharmacoepidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
Stockholm, Sweden
Øystein Karlstad, MscPharm, PhD
Senior researcher
Department of Chronic Diseases, Norwegian Institute of Public Health
Oslo, Norway
Maarit K. Leinonen, MD, PhD
Associate professor
Data and Analytics, Knowledge Brokers, Finnish Institute for Health and Welfare, Helsinki, Finland
Helsinki, Uusimaa, Finland
.jpg "Mette Nørgaard, MD, PhD photo")
Mette Nørgaard, MD, PhD
Chief physician, professor
Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
Aarhus N, Midtjylland, Denmark
Sallie-Anne Pearson, PhD
Professor
School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia, New South Wales, Australia
Johan Reutfors, MD, PhD
Associate professor
Centre for Pharmacoepidemiology, Karolinska Institutet, Sweden
Hein Stigum, PhD
Statistician
Department of Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway, United States
Kari Furu, PhD
Senior researcher
Department of Chronic Diseases & Centre for Fertility and Health, Norwegian Institute of Public Health, Norway
Jacqueline Cohen, PhD (she/her/hers)
Senior researcher
Department of Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway, Norway
Helga Zoega
Associate professor/professor
University of New South Wales - Sydney, Australia
Objective: To evaluate whether children who are prenatally exposed to antipsychotic medication are at increased risk of neurocognitive impairment, including neurocognitive disorders and poor academic performance.
Methods: Our population-based cohort study used nationwide register data on pregnant women and their live-born singletons from Denmark, Finland, Iceland, Norway, and Sweden born between 2000 and 2020. We defined prenatal exposure to antipsychotics as maternal prescription fills from the first day of last menstrual period to date of birth. To control for confounding, we restricted to women with a history of psychiatric disorders (diagnosis of a psychiatric condition in the 12 months before pregnancy start based on ICD-10 codes: F10-F98 excluding F50-9, X60-X84, and Y10-Y34) and applied propensity score (PS) overlap weights for a range of covariates. Cox proportional hazard regression yielded PS-weighted hazard ratios (HRs) and 95% confidence intervals (CIs) for intellectual-, speech-, language- and learning disorders and a composite outcome of any of these neurocognitive disorders. For children born between 2000 and 2011, we also assessed risk of poor academic performance in mathematics and language arts. Poor performance was defined as scoring in the lowest 25th percentile on standardised tests administered in school and PS-weighted risk ratios were estimated using Poisson regression. The individual-level data from Finland, Iceland, Norway, and Sweden were pooled and analysed together and data from Denmark was analysed separately using the same analysis program on harmonized datasets. The results were pooled using fixed-effects meta-analysis.
Results: Among 213 302 children of mothers with a psychiatric disorder, 11 626 (5.5%) were prenatally exposed to antipsychotics. In total, 4194 (1.9%) children had at least one neurocognitive disorder and the median length of follow up was 6.7 years. Among the subpopulation of children in the academic cohort 40 969 (90%) participated in school tests. For any antipsychotic exposure, the PS adjusted risk ratios did not suggest an increased risk of any neurocognitive disorder, 1.06 (95% CI 0.94 to 1.20), nor poor academic performance in mathematics, 1.04 (95% CI 0.91 to 1.18), or language arts, 1.00 (95% CI 0.87 to 1.15). Assessed outcomes were also not associated with an increased risk from prenatal exposure to quetiapine (n=4492), olanzapine (n=400), perphenazine (n=661), aripiprazole (n=523), and levomepromazine (n=380) monotherapy. Although, we observed a marginal association between chlorpromazine (n=225) and any neurocognitive disorder, weighted HR 1.65 (95%CI 0.99 to 2.75).
Conclusions: Our findings suggest no increased risk of neurocognitive disorders or poor academic performance after prenatal exposure to antipsychotics among children of mothers with a psychiatric disorder. Results regarding child neurocognitive development are reassuring for women managing psychiatric disorders who may need antipsychotics during pregnancy. A potential association between chlorpromazine and neurocognitive disorders should be followed up in future studies.