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Prenatal exposure to antipsychotic agents and the risk of congenital malformations in children: a systematic review and meta-analysis.

Wang, Z; Brauer, R; Man, KKC; Alfageh, B; Mongkhon, P; Wong, ICK; (2021) Prenatal exposure to antipsychotic agents and the risk of congenital malformations in children: a systematic review and meta-analysis. British Journal of Clinical Pharmacology 10.1111/bcp.14839. (In press).

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Abstract

OBJECTIVE: To evaluate the association between antipsychotic use in pregnancy and the risk of congenital malformations in children. DATA SOURCES: Searches of PubMed, EMBASE, PsycINFO and Cochrane Library were conducted from inception to 06 Jan 2020 using keywords: antipsychotics, pregnancy, pregnancy complication and congenital abnormalities. STUDY SELECTION: Of 38 reports initially identified as being of potential interest, 13 studies met our inclusion criteria: English observational studies that examined the association between gestational antipsychotic use and congenital malformations in children. DATA EXTRACTION: Data were extracted independently by two investigators including the publication year, study site, study period, data source, study design, sample size, medication exposure, exposure period and pregnancy definition, exposure as well as outcome ascertainment, selection of study and comparison group, confounding adjustment, statistical analysis, and method of linkage between mother and children. Risk estimates were pooled using a random-effect model and the I2 statistic was used to evaluate the degree of heterogeneity. RESULTS: 13 studies met our systematic review inclusion criteria. Six studies with a total of 2,515,272 pregnancy episodes were included in our meta-analysis which provided a pooled adjusted risk ratio of 1.23, 95% confidence interval: 0.96-1.58. The I2 result showed moderate heterogeneity between studies (I2 =35.2%, p=0.173). CONCLUSIONS: We did not find strong evidence of an association between prenatal exposure to antipsychotic medications and the risk of congenital malformations in children. We recommend further studies investigate this association, focusing on specific medication classes and dose responses, which would help clinicians decide whether or not to prescribe certain antipsychotics during pregnancy.

Type: Article
Title: Prenatal exposure to antipsychotic agents and the risk of congenital malformations in children: a systematic review and meta-analysis.
Location: England
DOI: 10.1111/bcp.14839
Publisher version: https://doi.org/10.1111/bcp.14839
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Antipsychotics, Congenital malformation, Pregnancy
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Life Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Life Sciences > UCL School of Pharmacy
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Life Sciences > UCL School of Pharmacy > Practice and Policy
URI: https://discovery.ucl.ac.uk/id/eprint/10126142
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