Association between prenatal antipsychotic exposure and the risk of attention-deficit/hyperactivity disorder and autism spectrum disorder: a systematic review and meta-analysis

• Published in: Neuroscience and biobehavioral reviews Vol. 160; p. 105635
• Main Authors: Wang, Zixuan, Yuen, Andrew SC, Wong, Kirstie HTW, Chan, Adrienne YL, Coghill, David, Simonoff, Emily, Lau, Wallis CY, Wong, Ian CK, Park, Sohee, Man, Kenneth KC
• Format: Journal Article
• Language: English
• Published: United States Elsevier Ltd 01-05-2024
• Subjects: Antipsychotic; Attention-deficit/hyperactivity disorder; Autism spectrum disorder; Pregnancy; Pregnancy; Antipsychotic; Attention-deficit/hyperactivity disorder; Autism spectrum disorder
• ISSN: 0149-7634; 1873-7528; 1873-7528
• DOI: 10.1016/j.neubiorev.2024.105635

The paucity of evidence regarding the safety of gestational antipsychotic exposure has led to treatment discontinuation in pregnant women with severe mental health conditions. This systematic review and meta-analysis aimed to summarise the current evidence on the association between gestational antipsychotic exposure and attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) in children (Study protocol registered in PROSPERO:CRD42022311354). Five studies included in our meta-analysis with around 8.6 million pregnancy episodes in nine different countries/regions. Results from our meta-analysis indicate that the heightened risks of ASD and ADHD in children gestationally exposed to antipsychotics appear to be attributable to maternal characteristics, rather than having a causal relationship with the antipsychotic exposure during pregnancy. The results underscore the importance of meticulously monitoring the neurodevelopment of children born to mothers with mental illnesses, which can facilitate early interventions and provide requisite support.
•Increased risks of ADHD and ASD observed in children with prenatal antipsychotic exposure appear to be attributable to maternal characteristics, rather than having a causal relation to the antipsychotics itself.•Antipsychotic treatment during pregnancy could be considered when clinically indicated.•Future research investigating the effect of individual antipsychotics or dosing regimens is suggested.