Evidence map›Paper›PMID 25972273›Full record

ArticleBMJ (Clinical research ed.)2015

Antipsychotic drug use in pregnancy: high dimensional, propensity matched, population based cohort study.

Simone N Vigod, Tara Gomes, Andrew S Wilton, Valerie H Taylor, Joel G Ray

Registry-linked trialAbstract readEvaluation Study
PubMed Full text at PMC Publisher
In one paragraph

Article in BMJ (Clinical research ed.), 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02970721 (Use of Psychotropic Medications Among Pregnant Women With Bipolar Disorder), which is not on this map. Cited by 51 papers, 8 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
51citing papers in PubMed, 8 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT02970721 completednot on this mapstarted 2016, after this paper: background citation

Use of Psychotropic Medications Among Pregnant Women With Bipolar Disorder: Patterns, Determinants, and Impact on Perinatal Outcomes

TypeobservationalSponsorWestern University, CanadaRan2016 to 2018Enrolled3,357ConditionsBipolar Disorder, Pregnancy ComplicationsArmsAntipsychotic, Antidepressant, Antipsychotic and Antidepressant
3 · Its place in the literature

Who cites it

51 citing papers in PubMed, 8 syntheses or guidelines pooled it.

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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

5 authors.

Simone N VigodWomen's College Research Institute; Department of Psychiatry, University of Toronto, Toronto, Ontario M5S 1B2, Canada Institute for Clinical Evaluative Sciences, Toronto, Ontario M4N 3M5 Department of Psychiatry, Women's College Hospital; University of Toronto, Toronto, Ontario simone.vigod@wchospital.ca.
Tara GomesInstitute for Clinical Evaluative Sciences, Toronto, Ontario M4N 3M5.
Andrew S WiltonInstitute for Clinical Evaluative Sciences, Toronto, Ontario M4N 3M5.
Valerie H TaylorWomen's College Research Institute; Department of Psychiatry, University of Toronto, Toronto, Ontario M5S 1B2, Canada Department of Psychiatry, Women's College Hospital; University of Toronto, Toronto, Ontario.
Joel G RayInstitute for Clinical Evaluative Sciences, Toronto, Ontario M4N 3M5 Departments of Medicine and Obstetrics and Gynaecology, St Michael's Hospital, University of Toronto, Toronto, Ontario M5B 1W8.

Funding

Canadian Institutes of Health Research
6 · The paper itself

Abstract

objectiveTo evaluate maternal medical and perinatal outcomes associated with antipsychotic drug use in pregnancy.

designHigh dimensional propensity score (HDPS) matched cohort study.

settingMultiple linked population health administrative databases in the entire province of Ontario, Canada.

participantsAmong women who delivered a singleton infant between 2003 and 2012, and who were eligible for provincially funded drug coverage, those with ≥ 2 consecutive prescriptions for an antipsychotic medication during pregnancy, at least one of which was filled in the first or second trimester, were selected. Of these antipsychotic drug users, 1021 were matched 1:1 with 1021 non-users by means of a HDPS algorithm.

main outcome measuresThe main maternal medical outcomes were gestational diabetes, hypertensive disorders of pregnancy, and venous thromboembolism. The main perinatal outcomes were preterm birth (<37 weeks), and a birth weight <3rd or >97th centile. Conditional Poisson regression analysis was used to generate rate ratios and 95% confidence intervals, adjusting for additionally prescribed non-antipsychotic psychotropic medications.

resultsCompared with non-users, women prescribed an antipsychotic medication in pregnancy did not seem to be at higher risk of gestational diabetes (rate ratio 1.10 (95% CI 0.77 to 1.57)), hypertensive disorders of pregnancy (1.12 (0.70 to 1.78)), or venous thromboembolism (0.95 (0.40 to 2.27)). The preterm birth rate, though high among antipsychotic users (14.5%) and matched non-users (14.3%), was not relatively different (rate ratio 0.99 (0.78 to 1.26)). Neither birth weight <3rd centile or >97th centile was associated with antipsychotic drug use in pregnancy (rate ratios 1.21 (0.81 to 1.82) and 1.26 (0.69 to 2.29) respectively).

conclusionsAntipsychotic drug use in pregnancy had minimal evident impact on important maternal medical and short term perinatal outcomes. However, the rate of adverse outcomes is high enough to warrant careful assessment of maternal and fetal wellbeing among women prescribed an antipsychotic drug in pregnancy.

Indexed as

AdultAntipsychotic AgentsCohort StudiesDatabases, FactualFemaleFetal Growth RetardationHumansInfant, Low Birth WeightInfant, NewbornMatched-Pair AnalysisPoisson DistributionPregnancyPregnancy ComplicationsPremature BirthPropensity ScoreRegression AnalysisAntipsychotic Agents

Identifiers

PMID25972273
PMCPMC4430156

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.