Comparative Safety of Antipsychotic Medications and Mood Stabilizers During Pregnancy: A Systematic Review and Network Meta-analysis of Congenital Malformations and Prenatal Outcomes.

IF 7.4 2区医学 Q1 CLINICAL NEUROLOGY CNS drugs Pub Date : 2024-11-11 DOI:10.1007/s40263-024-01131-x

Enhui Wang, Yilin Liu, Yucheng Wang, Xinyu Han, Yifang Zhou, Lingli Zhang, Yanqing Tang

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Abstract

Background: A network meta-analysis was performed to evaluate the risk of congenital malformations and other prenatal outcomes in fetuses after exposure to antipsychotic medications and mood stabilizers during pregnancy.

Methods: We searched the PubMed, EMBASE, and Cochrane CENTRAL databases up to 15 December 2023, to identify experimental and observational studies comparing antipsychotic and mood stabilizer treatments with control treatments (no exposure). The primary outcome of the study was the incidence of congenital malformations and the secondary outcomes were preterm birth and spontaneous abortion. Additionally, two authors independently assessed the risk of bias in each domain of the included studies using the ROBINS-I tool and evaluated the quality of evidence using the CINeMA rating tool.

Results: The literature search identified 18,334 potential records, and 22 studies involving 3,042,997 pregnant women were ultimately included. Compared with the unexposed group, quetiapine [odds ratio (OR), 1.19; 95% credible interval (CrI), 1.01-1.39], aripiprazole (OR, 1.30; 95% CrI 1.10-1.65), olanzapine (OR, 1.33; 95% CrI 1.11-1.64), risperidone (OR, 1.43; 95% CrI 1.18-1.77), and lithium (OR, 1.61; 95% CrI 1.07-2.30) were associated with a slightly increased risk of congenital malformations. In contrast, lamotrigine (OR, 1.21; 95% CrI 0.86-1.64), ziprasidone (OR, 1.14; 95% CrI 0.73-1.72), and haloperidol (OR, 1.26; 95% CrI 0.90-1.75) did not show significant differences compared with the unexposed group, with narrower credible intervals.

Conclusions: The evidence from this analysis suggests that, overall, quetiapine has the lowest teratogenic risk when used during pregnancy, making it the safer option for pregnant women. Lamotrigine and haloperidol follow closely behind. At the same time, the use of lurasidone and ziprasidone should be approached with caution, and further clinical studies are necessary to better assess their safety.

Systematic review registration: PROSPERO CRD4201811373.

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妊娠期抗精神病药物和情绪稳定剂的安全性比较：先天性畸形和产前结果的系统综述和网络 Meta 分析》（A Systematic Review and Network Meta-analysis of Congenital Malformations and Prenatal Outcomes.

背景：我们进行了一项网络荟萃分析，以评估孕期接触抗精神病药物和情绪稳定剂后胎儿先天性畸形和其他产前结果的风险：我们检索了截至 2023 年 12 月 15 日的 PubMed、EMBASE 和 Cochrane CENTRAL 数据库，以确定比较抗精神病药物和情绪稳定剂治疗与对照治疗（无暴露）的实验性和观察性研究。研究的主要结果是先天性畸形的发生率，次要结果是早产和自然流产。此外，两位作者使用 ROBINS-I 工具独立评估了纳入研究的各个领域的偏倚风险，并使用 CINeMA 评分工具评估了证据质量：文献检索发现了 18,334 条潜在记录，最终纳入了 22 项研究，涉及 3,042,997 名孕妇。与未暴露组相比，喹硫平[几率比（OR），1.19；95% 可信区间（CrI），1.01-1.39]、阿立哌唑（OR，1.30；95% CrI，1.10-1.65）、奥氮平（OR，1.33；95% CrI 1.11-1.64）、利培酮（OR，1.43；95% CrI 1.18-1.77）和锂（OR，1.61；95% CrI 1.07-2.30）与先天性畸形风险略有增加有关。相比之下，拉莫三嗪（OR，1.21；95% CrI 0.86-1.64）、齐拉西酮（OR，1.14；95% CrI 0.73-1.72）和氟哌啶醇（OR，1.26；95% CrI 0.90-1.75）与未暴露组相比没有显著差异，可信区间较窄：本次分析的证据表明，总体而言，喹硫平在妊娠期间的致畸风险最低，因此对孕妇来说是更安全的选择。拉莫三嗪和氟哌啶醇紧随其后。同时，应谨慎使用鲁拉西酮和齐拉西酮，有必要开展进一步的临床研究，以更好地评估其安全性：系统综述注册：PREMCORD4201811373。

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来源期刊

CNS drugs 医学-精神病学

CiteScore

12.00

自引率

3.30%

发文量

审稿时长

6-12 weeks

期刊介绍： CNS Drugs promotes rational pharmacotherapy within the disciplines of clinical psychiatry and neurology. The Journal includes: - Overviews of contentious or emerging issues. - Comprehensive narrative reviews that provide an authoritative source of information on pharmacological approaches to managing neurological and psychiatric illnesses. - Systematic reviews that collate empirical evidence to answer a specific research question, using explicit, systematic methods as outlined by the PRISMA statement. - Adis Drug Reviews of the properties and place in therapy of both newer and established drugs in neurology and psychiatry. - Original research articles reporting the results of well-designed studies with a strong link to clinical practice, such as clinical pharmacodynamic and pharmacokinetic studies, clinical trials, meta-analyses, outcomes research, and pharmacoeconomic and pharmacoepidemiological studies. Additional digital features (including animated abstracts, video abstracts, slide decks, audio slides, instructional videos, infographics, podcasts and animations) can be published with articles; these are designed to increase the visibility, readership and educational value of the journal’s content. In addition, articles published in CNS Drugs may be accompanied by plain language summaries to assist readers who have some knowledge of, but not in-depth expertise in, the area to understand important medical advances.