Introduction: Data from The National Register of Antipsychotic Medications in Pregnancy (NRAMP) cohort study suggests that women taking antipsychotic medications are generally at higher-than-population risk of GDM.
Objectives: To investigate the impact of type and dose of atypical antipsychotic monotherapy during pregnancy on the incidence of GDM.
Methods: A subset (n=186) of NRAMP participants, recruited between 2005 and December 2014, was identified: pregnant women, taking either no antipsychotic, or a single atypical antipsychotic during their first trimester. Exclusion criteria were: pre-existing diabetes, use of clozapine, and miscarriage prior to 24 weeks gestation (ie unlikely to have been screened for GDM). Atypical antipsychotics were grouped as follows: quetiapine (n=104), olanzapine/risperidone/other (n=62), and none (n=20). Women were interviewed by telephone several times throughout pregnancy. Multivariable logistic regression was performed to determine the effect of antipsychotics on the risk of GDM when known risk factors for GDM are taken into account.
Results:
GDM was diagnosed in 10% of participants taking no antipsychotic, 13.5% of quetiapine participants, 35.5% of olanzapine participants, 41.7% of risperidone participants, and 33.3% of ‘other’ participants (p=0.005 for difference between groups). In the adjusted model, GDM was more likely to occur with higher antipsychotic dose (OR 3.08, p=0.013), family history of diabetes (OR 3.5, p=0.008), and higher pre-pregnancy BMI (OR 1.07, p=0.041). Women in the olanzapine/risperidone/other group had a higher GDM risk than the quetiapine group (OR 2.74; p=0.023). There was no statistically significant difference between the quetiapine and no antipsychotic groups.
Conclusions: The incidence of GDM in women who take antipsychotics during pregnancy is high, with olanzapine and risperidone being more diabetogenic than quetiapine. Higher doses of medication also significantly increase the risk of GDM. Traditional risk factors such as family history and BMI remain important in these women.