COMMENTARY

Atypical Antipsychotics Heighten Gestational Diabetes Risk

Peter M. Yellowlees, MBBS, MD

Disclosures

December 11, 2018

This is the Medscape Psychiatry Minute. I'm Dr Peter Yellowlees.

We know that the atypical antipsychotics are associated with metabolic side effects, but are these drugs also risk factors for gestational diabetes? Now a team of investigators[1] from Harvard Medical School has examined the risk of developing gestational diabetes associated with the continuation of treatment with aripiprazole, ziprasidone, quetiapine, risperidone, and olanzapine during pregnancy, compared with discontinuation of these antipsychotic drugs in 1,543,334 pregnancies detailed in a Medicaid database.

The researchers found that compared with women who discontinued use of an atypical antipsychotic medication before the start of pregnancy, women who continued treatment with olanzapine or quetiapine had an increased risk for gestational diabetes. They concluded that this may be explained by the metabolic effects associated with these two drugs.

So how can these results help our practice? It is well known that the atypical antipsychotics generally increase the risk for obesity and the metabolic syndrome, particularly quetiapine and olanzapine. We now know that this effect is also apparent in pregnancy. The clinical message here is that if a patient requires continuation therapy with antipsychotics during pregnancy, first ensure that their weight and metabolic status are carefully monitored. Also, when prescribing, you should consider using first-generation antipsychotics in preference to the atypicals; but if you must use the latter, you should avoid quetiapine and olanzapine. Perhaps more important, this study serves as a reminder of the potential life-shortening effects of the atypical antipsychotics, which should be used judiciously at all times.

Thank you for listening to this Medscape Psychiatry Minute. Do continue to enjoy your practice.

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