Second-generation antipsychotics and pregnancy complications

Eur J Clin Pharmacol. 2020 Jan;76(1):107-115. doi: 10.1007/s00228-019-02769-z. Epub 2019 Nov 3.


Purpose: To study if second-generation antipsychotic (S-GA) use during pregnancy is associated with an increased risk of pregnancy and neonatal complications.

Methods: A population-based birth cohort study using national register data extracted from the "Drugs and Pregnancy" database in Finland, years 1996-2016. The sampling frame included 1,181,090 pregnant women and their singleton births. Women were categorized into three groups: exposed to S-GAs during pregnancy (n = 4225), exposed to first-generation antipsychotics (F-GAs) during pregnancy (n = 1576), and unexposed (no purchases of S-GAs or F-GAs during pregnancy, n = 21,125). Pregnancy outcomes in S-GA users were compared with those in the two comparison groups using multiple logistic regression models.

Results: Comparing S-GA users with unexposed ones, the risk was increased for gestational diabetes (adjusted odds ratio, OR 1.43; 95% CI 1.25-1.65), cesarean section (OR 1.35; 95% CI 1.18-1.53), being born large for gestational age (LGA) (OR 1.57; 95% CI 1.14-2.16), and preterm birth (OR 1.29; 95% CI 1.03-1.62). The risk for these outcomes increased further with continuous S-GA use. Infants in the S-GA group were also more likely to suffer from neonatal complications. Comparing S-GA users with the F-GA group, the risk of cesarean section and LGA was higher (OR 1.25, 95% CI 1.03-1.51; and OR 1.89, 95% CI 1.20-2.99, respectively). Neonatal complications did not differ between the S-GA and F-GA groups.

Conclusions: Prenatal exposure to S-GAs is associated with an increased risk of pregnancy complications related to impaired glucose metabolism. Neonatal problems are common and occur similarly in S-GA and F-GA users.

Keywords: Neonatal complications; Pregnancy; Pregnancy complications; Second-generation antipsychotics.

MeSH terms

  • Adult
  • Antipsychotic Agents / adverse effects*
  • Cesarean Section
  • Cohort Studies
  • Diabetes, Gestational
  • Female
  • Finland
  • Glucose / metabolism
  • Humans
  • Infant, Newborn
  • Pregnancy
  • Pregnancy Complications / etiology*
  • Pregnancy Outcome
  • Premature Birth
  • Risk Factors
  • Young Adult


  • Antipsychotic Agents
  • Glucose