New research offers some encouraging news for expectant mothers. The Journal of Clinical Psychiatry reports that long-acting injectable antipsychotics carry no greater obstetric risk in pregnancy than their oral counterparts.
The study, based on a global analysis of medical records, challenges concerns that long-acting forms of common psychiatric medications could raise the risk of gestational diabetes or hypertensive disorders. It also could help expand treatment options for women with serious mental illness.
The study, led by researchers at the University of California, compared outcomes among more than 4,000 pregnant patients treated with second-generation antipsychotics such as aripiprazole, risperidone, paliperidone, and olanzapine.
After matching patients to account for medical and psychiatric differences, the researchers discovered no clinically meaningful distinctions between long-acting injectable antipsychotics (LAIAs) and their oral equivalents. Rates of gestational diabetes, preeclampsia, eclampsia, new-onset hypertension, and cesarean delivery remained consistent across groups.
A Widening Need, and Limited Data
For years, clinicians have wrestled with the challenges inherent in writing prescriptions for reproductive-age women. They must strike an improbable balance. Weighing the threats of untreated mental illness during pregnancy (and all that entails) against the uncertainty that’s long swirled around fetal exposure to psychotropic medications.
Oral antipsychotics have always earned the bulk of scientific scrutiny, with most studies revealing that they pose low teratogenic risk. That being said, some evidence still hints at elevated concerns for specific drugs, such as risperidone and paliperidone.
Long-acting injectables have made things even more challenging. They offer clearer benefits for adherence, relapse prevention, and hospitalization reduction – especially among patients with severe conditions such as schizophrenia or bipolar disorder. Yet safety information hasn’t kept pace with real-world use. The existing research has focused largely on case reports and small retrospective reviews. Until now.
Methodology
Working with TriNetX, a global health research network with data from 148 organizations and more than 160 million patient records, the researchers singled out pregnant women over 18. They focused on those who’d received prescriptions for either long-acting injectable or oral second-generation antipsychotics.
To ensure an appropriate comparison, investigators matched patients in a 1:1 ratio across 26 medical and sociodemographic variables ranging from age and race to nicotine dependence, diabetes, bipolar disorder, and concomitant psychiatric medications. After matching, each cohort consisted of 2,025 patients. Bipolar disorder emerged as the most common diagnosis, followed by schizophrenia. Roughly 40% of the women smoked. More than a third of them had a circulatory disorder.
No Difference in Obstetric Complications
Across the matched cohorts, 8.7% of patients on oral medications and 8.3% of those on LAIAs experienced one of four primary obstetric complications. Statistical analysis confirmed there were no differences between groups in:
- Gestational diabetes.
- Preeclampsia or eclampsia.
- New hypertensive diagnoses.
- Cesarean delivery rates.
Even when the researchers looked at the outcomes individually, the results remained consistent.
For many patients, treatment consistency is a lifesaving issue rather than a convenience. Missed oral doses, abrupt discontinuation, or treatment gaps can trigger rapid relapse, undermining prenatal care or exposing the fetus to harmful behaviors.
LAIAs, on the other hand, help stabilize treatment, curb relapse risk, and might even shield against postpartum psychosis or mood episodes, which could have huge consequences for maternal health.
As a result, these results carry implications beyond pregnancy, suggesting benefits across the entire perinatal period.
A New Path Forward
Despite some lingering unanswered questions, this new research adds to the mounting evidence that backs up the careful, clinically guided use of long-acting injectables during pregnancy. Rather than assuming the injectable route comes with added risk, the results suggest clinicians might weigh LAIAs alongside oral options. They can instead focus on individual drug characteristics, patient history, and stability of illness.
For pregnant women navigating complex psychiatric conditions, treatment decisions hinge on much more than mitigating risk. These patients (obviously) want to stay healthy, preserve their relationships, and just be good parents. This new data suggests that, at least as far as obstetric complications are concerned, long-acting antipsychotics might be a viable path forward.
Further Reading
How Tardive Dyskinesia Impacts Patients Using Antipsychotics
