Safety of GLP-1 Receptor Agonists and Other Second-Line Antidiabetics in Early Pregnancy

JAMA Internal Medicine, Год журнала: 2023, Номер 184(2), С. 144 - 144

Опубликована: Дек. 11, 2023

Importance Increasing use of second-line noninsulin antidiabetic medication (ADM) in pregnant individuals with type 2 diabetes (T2D) may result fetal exposure, but their teratogenic risk is unknown. Objective To evaluate periconceptional ADMs and whether it associated increased major congenital malformations (MCMs) the infant. Design, Setting, Participants This observational population-based cohort study used data from 4 Nordic countries (2009-2020), US MarketScan Database (2012-2021), Israeli Maccabi Health Services database (2009-2020). Pregnant women T2D were identified live-born infants followed until up to 1 year after birth. Exposure Periconceptional exposure was defined as or more prescription fill sulfonylureas, dipeptidyl peptidase (DPP-4) inhibitors, glucagon-like peptide (GLP-1) receptor agonists, sodium-glucose cotransporter (SGLT2) insulin (active comparator) 90 days before pregnancy end first trimester. Main Outcomes Measures Relative risks (RRs) 95% CIs for MCMs estimated using log-binomial regression models, adjusting key confounders each meta-analyzed. Results differed between (32, 295, 73 per 100 000 pregnancies Nordics, US, Israel, respectively), over period, especially US. The standardized prevalence 3.7% all (n = 3 514 865), 5.3% born 51 826), among exposed sulfonylureas 9.7% 1362); DPP-4 6.1% 687); GLP-1 8.3% 938); SGLT2 7.0% 335); insulin, 7.8% 5078). Compared adjusted RRs 1.18 (95% CI, 0.94-1.48), 0.83 0.64-1.06), 0.95 0.72-1.26), 0.98 0.65-1.46) respectively. Conclusions Relevance Use rapidly increasing treatment other indications, resulting an number pregnancies. Although some estimates imprecise, results did not indicate a large above conferred by maternal requiring treatment. reassuring, confirmation studies needed, continuous monitoring will provide precise accumulate.

Язык: Английский

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Risk of congenital malformations associated with first-trimester exposure to antipsychotics: a propensity score-weighted population-based cohort study

European Psychiatry, Год журнала: 2024, Номер 67(1)

Опубликована: Янв. 1, 2024

Abstract Background There is growing concern regarding teratogenic effect of antipsychotics. Previous research assessing association between antipsychotics and congenital malformations (CMs) yielded mixed results were all derived from Western countries. We aimed to examine risk major organ/system-specific CMs associated with prenatal antipsychotic exposure in Hong Kong. Methods This population-based study identified women aged 15–50 years who delivered their first/singleton child 2003–2018 public healthcare service database. Propensity score (PS)-weighted logistic-regression analyses performed following first-trimester classes (second- first-generation antipsychotic; SGA FGA) six most frequently-prescribed individual Results Of 465,069 women, 419 420 redeemed ≥1 prescription FGA during first-trimester, respectively. Prevalence any was 4.9% (95%CI:4.9–5.0%) unexposed-infants, 9.1% (6.7–12.3%) SGA-exposed infants, 6.2% (4.3–9.0%) FGA-exposed infants. (adjusted-odds-ratio: 2.11 [95%CI:1.19–3.86]) increased CMs. finding consistent sensitivity addressing misclassification confounding by treatment indication, but not PS-matched analysis. Elevated observed infants exposed high-dose olanzapine (7.50 [1.65–36.13]) quetiapine (15.03 [4.86–56.72]), wide-CIs. Organ/system-specific SGA, or Conclusion a small consistently affirmed analyses, precluding firm conclusions. Research large sample size clarifying comparative safety on specific warranted.

Язык: Английский

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Antipsychotic use during pregnancy and outcomes in pregnant individuals and newborns

Journal of Affective Disorders, Год журнала: 2025, Номер unknown

Опубликована: Янв. 1, 2025

Язык: Английский

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Mental Health Disorders in Pregnancy and the Early Postpartum

Опубликована: Янв. 18, 2025

Mental health disorders are common in pregnancy and after childbirth with over 10% of women manifesting some form mental illness during this time. Maternity services will encounter symptoms that vary severity from mild self-limiting to potentially life-threatening. These conditions carry risks for both the woman fetus/newborn. Detecting with, or at risk of, a serious disorder enabling them access appropriate care timely fashion is shared responsibility. However, given frequency contact they have through period, maternity pivotal role. From perspective, high-risk pregnancies those primarily associated (psychotic illnesses, bipolar severe depressive episodes). Healthcare professionals caring pregnant should skills detect identify how specialist care.

Язык: Английский

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Maternal antipsychotic use during pregnancy and congenital malformations

American Journal of Obstetrics & Gynecology MFM, Год журнала: 2023, Номер 5(6), С. 100950 - 100950

Опубликована: Апрель 2, 2023

Existing data may underestimate the potential teratogenic effects of prenatal antipsychotic exposure because lacking on miscarriages and induced abortions.This study aimed to present a comprehensive analysis based information pregnancies ending in termination, miscarriage, stillbirth, live birth.We conducted population-based cohort Denmark clinically recognized singleton with first-trimester scan performed from 2008 2017. We compared risk major malformations between exposed antipsychotics first trimester unexposed pregnancies. In secondary analyses, comparison was made women who used before but not during pregnancy (discontinuers). weighted log-binomial regression estimate adjusted prevalence ratios propensity score fine stratifications for confounding control. 4 sensitivity including sibling-controlled analysis.Of 503,158 pregnancies, 1252 (0.2%) were filled an prescription trimester. Major 7.3% antipsychotic-exposed 5.1% 6.0% discontinuers' The ratio 1.23 (95% confidence interval, 1.01-1.50) among attenuated 1.14 0.88-1.48) discontinuers 1.08 0.47-2.49) sibling analysis. Similar findings observed cardiac malformations. Results consistent classes individual antipsychotics, remained robust across analyses.Our suggest limited or no overall effect exposure. For estimations very few cases, further studies sufficient sample sizes are warranted.

Язык: Английский

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Switching to long-acting injectable antipsychotics: pharmacological considerations and practical approaches

Expert Opinion on Pharmacotherapy, Год журнала: 2023, Номер 24(13), С. 1463 - 1489

Опубликована: Июнь 24, 2023

Long-acting injectable antipsychotics (LAIs) are an effective, but potentially underutilized treatment option in schizophrenia and other severe mental illnesses. Prescribing information typically focuses on how to initiate from the corresponding oral formulations. However, clinical practice scenarios, such as switching or LAIs, occur frequently, requiring guidance.Pharmacodynamic properties of their relation rebound symptoms. Pharmacokinetic LAIs implications for approaches. Specific approaches LAIs.The LAI landscape has evolved significantly last decade with more formulations available, longer dosing intervals, extended indications. currently available have various shortcomings, e.g. short need supplementation, loading regimens, deep intramuscular injection and/or restricted Recent improvements include a one-day initiation aripiprazole lauroxil, monohydrate once-monthly, risperidone situ microparticles subcutaneous risperidone. Future developments should focus administration, expansion beyond antipsychotic agents indications bipolar disorder. In future, might become first-line after initial stabilization chronic disorders maintenance presence significant non-adherence.

Язык: Английский

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In Memoriam—Helle Kieler (1956–2024)

Pharmacoepidemiology and Drug Safety, Год журнала: 2025, Номер 34(1)

Опубликована: Янв. 1, 2025

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Antipsychotic continuation during pregnancy and risk of postpartum relapse in women with schizophrenia: nationwide register-based study

The British Journal of Psychiatry, Год журнала: 2025, Номер unknown, С. 1 - 8

Опубликована: Янв. 10, 2025

Background Women with schizophrenia frequently discontinue antipsychotic medications during pregnancy. However, evidence on the risk of postpartum relapse associated use pregnancy is lacking. Aims To investigate within-individual association between continuation and in women schizophrenia. Method This retrospective cohort study used data who gave live birth 2007 2018 identified from National Health Information Database South Korea. were classified according to patterns 12 months before delivery as non-users, discontinuers continuers. Relapse was defined admission for psychosis (ICD-10, F20–29). The incidence rate ratio (IRR) 6-month period estimated using conditional Poisson regression, reference set 2 1 years delivery. Additionally, we calculated relative ratios (RRRs) IRRs different patterns. Results Among 3026 included analysis (median age 34 years, interquartile range 31–37), 0.56 times (RRR, 95% CI 0.36–0.87) lower continuers (IRR = 1.31, 0.89–1.72) than 2.34, 1.87–2.91). discontinuers, did not change significantly timing discontinuation (trend P 0.946). Conclusions Antipsychotic a reduced Continuing antipsychotics would be recommended after risk–benefit assessment.

Язык: Английский

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Maternal mental disorders, psychotropic drugs, socioeconomic status, and offspring congenital anomalies

Journal of International Medical Research, Год журнала: 2025, Номер 53(1)

Опубликована: Янв. 1, 2025

Objective To evaluate whether there is an association between maternal mental health, purchase of psychotropic drugs, socioeconomic status and major congenital anomalies in offspring. Methods A register-based cohort study 6189 Finnish primiparous women who had a singleton delivery 2009 2015. Data on pregnancy outcomes, psychiatric diagnosis, prescription drug purchases offspring were obtained from national registers. Results Severe depressive disorders diagnosed 2.0% severe anxiety 1.1%. During pregnancy, 9.6% purchased drugs. Of these women, 5.7% delivered with anomaly. Women drugs increased risk delivering child compared did not Multivariate regression analysis showed that benzodiazepines the (odds ratio 2.11 [95% confidence interval 1.17 to 3.81]). Pregnant purchasing more often lived alone smoked, higher body mass index, lower annual income educational attainment than Conclusions Benzodiazepine use, but status, may be associated abnormalities

Язык: Английский

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Effects of Psychotropic Medications Taken by Pregnant Women on Newborn Medical Condition and Lactation Method

Neuropsychopharmacology Reports, Год журнала: 2025, Номер 45(1)

Опубликована: Янв. 30, 2025

ABSTRACT Background Maternal psychiatric condition during the perinatal period is relevant to children's cognitive development and mental health. Psychotropic medications are necessary maintain health of pregnant women with disorders, but they often avoided due concerns about adverse effects, such as congenital malformations abnormal neurodevelopment. A retrospective study disorders using psychotropic was performed clarify maternal child demographic data investigate whether affected Apgar score decision breastfeed. Methods Data who were referred from Department Obstetrics Gynecology Neuropsychiatry at Ehime University Hospital January 2014 December 2022 collected retrospectively. Pearson's chi‐squared test multiple regression analysis used for statistical analyses. Results total 226 included; 194 gave birth our hospital, whom 79 (40.7%) taking drugs time delivery. None children had malformations. There no relationship between use choice Multiple showed that only gestational weeks significantly associated weight ( p < 0.001) (1 min: = 0.030; 5 0.044). Conclusions The appears safe beneficial both their children, breastfeeding should be considered even if mother continues take medication. To these points, prospective studies large samples several countries needed.

Язык: Английский

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