Antipsychotic use in pregnancy and risk of attention/deficit-hyperactivity disorder and autism spectrum disorder: a Nordic cohort study
Abstract Background Antipsychotics are increasingly used among women of childbearing age and during pregnancy. Objective To determine whether children exposed to antipsychotics in utero are at increased risk of attention-deficit/hyperactivity disorder (ADHD) or autism spectrum disorder (ASD), accoun...
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ftfolkehelseins:oai:fhi.brage.unit.no:11250/2838582 2023-05-15T16:52:29+02:00 Antipsychotic use in pregnancy and risk of attention/deficit-hyperactivity disorder and autism spectrum disorder: a Nordic cohort study Halfdanarson, Oskar Cohen, Jacqueline Mallory Karlstad, Øystein Cesta, Carolyn E. Bjørk, Marte-Helene Håberg, Siri Eldevik Einarsdottir, Kristjana Furu, Kari Gissler, Mika Hjellvik, Vidar Kieler, Helle Leinonen, Maarit Nørgaard, Mette Essen, Buket Öztürk Ulrichsen, Sinna Pilgaard Reutfors, Johan Zoega, Helga 2021 application/pdf https://hdl.handle.net/11250/2838582 https://doi.org/10.1136/ebmental-2021-300311 eng eng Norges forskningsråd: 262700 Evidence-Based Mental Health. 2021, 1-9. urn:issn:1362-0347 https://hdl.handle.net/11250/2838582 https://doi.org/10.1136/ebmental-2021-300311 cristin:1985643 1-9 Evidence-Based Mental Health Peer reviewed Journal article 2021 ftfolkehelseins https://doi.org/10.1136/ebmental-2021-300311 2022-11-18T06:51:18Z Abstract Background Antipsychotics are increasingly used among women of childbearing age and during pregnancy. Objective To determine whether children exposed to antipsychotics in utero are at increased risk of attention-deficit/hyperactivity disorder (ADHD) or autism spectrum disorder (ASD), accounting for maternal diagnoses of bipolar, psychotic and other psychiatric disorders. Design Population-based cohort study, including a sibling analysis. Setting Nationwide data on all pregnant women and their live-born singletons in Denmark (1997-2017), Finland (1996-2016), Iceland (2004-2017), Norway (2004-2017), and Sweden (2006-2016). Participants 4 324 086 children were eligible for inclusion to the study cohort. Intervention Antipsychotic exposure in utero, assessed by pregnancy trimester, type of antipsychotic, and varying patterns of use. Main outcome measures Non-mutually exclusive diagnoses of ADHD and ASD. We used Cox proportional hazard models to calculate hazard ratios (HRs) controlling for maternal psychiatric disorders and other potential confounding factors. Findings Among 4 324 086 singleton births, 15 466 (0.4%) were exposed to antipsychotics in utero. During a median follow-up of 10 years, we identified 72 257 children with ADHD and 38 674 children with ASD. Unadjusted HRs were raised for both outcomes but shifted substantially towards the null after adjustment; 1.10 (95%CI 1.00 to 1.27) for ADHD and 1.12 (0.97 to 1.29) for ASD. Adjusted HRs remained consistent by trimester of exposure and type of antipsychotic. Comparing in utero exposure with pre-pregnancy use yielded HRs of 0.74 (0.62 to 0.87) for ADHD and 0.88 (0.70 to 1.10) for ASD. Sibling analyses yielded HRs of 1.14 (0.79 to 1.64) for ADHD and 1.34 (0.75 to 2.39) for ASD. Discussion Our findings suggest little or no increased risk of child ADHD or ASD after in utero exposure to antipsychotics. Clinical implications Results regarding child neurodevelopment are reassuring for women who need antipsychotics during pregnancy. publishedVersion Article in Journal/Newspaper Iceland Norwegian Institute of Public Health Open Repository (Brage) Norway Evidence Based Mental Health ebmental-2021-30 |
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Open Polar |
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Norwegian Institute of Public Health Open Repository (Brage) |
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ftfolkehelseins |
language |
English |
description |
Abstract Background Antipsychotics are increasingly used among women of childbearing age and during pregnancy. Objective To determine whether children exposed to antipsychotics in utero are at increased risk of attention-deficit/hyperactivity disorder (ADHD) or autism spectrum disorder (ASD), accounting for maternal diagnoses of bipolar, psychotic and other psychiatric disorders. Design Population-based cohort study, including a sibling analysis. Setting Nationwide data on all pregnant women and their live-born singletons in Denmark (1997-2017), Finland (1996-2016), Iceland (2004-2017), Norway (2004-2017), and Sweden (2006-2016). Participants 4 324 086 children were eligible for inclusion to the study cohort. Intervention Antipsychotic exposure in utero, assessed by pregnancy trimester, type of antipsychotic, and varying patterns of use. Main outcome measures Non-mutually exclusive diagnoses of ADHD and ASD. We used Cox proportional hazard models to calculate hazard ratios (HRs) controlling for maternal psychiatric disorders and other potential confounding factors. Findings Among 4 324 086 singleton births, 15 466 (0.4%) were exposed to antipsychotics in utero. During a median follow-up of 10 years, we identified 72 257 children with ADHD and 38 674 children with ASD. Unadjusted HRs were raised for both outcomes but shifted substantially towards the null after adjustment; 1.10 (95%CI 1.00 to 1.27) for ADHD and 1.12 (0.97 to 1.29) for ASD. Adjusted HRs remained consistent by trimester of exposure and type of antipsychotic. Comparing in utero exposure with pre-pregnancy use yielded HRs of 0.74 (0.62 to 0.87) for ADHD and 0.88 (0.70 to 1.10) for ASD. Sibling analyses yielded HRs of 1.14 (0.79 to 1.64) for ADHD and 1.34 (0.75 to 2.39) for ASD. Discussion Our findings suggest little or no increased risk of child ADHD or ASD after in utero exposure to antipsychotics. Clinical implications Results regarding child neurodevelopment are reassuring for women who need antipsychotics during pregnancy. publishedVersion |
format |
Article in Journal/Newspaper |
author |
Halfdanarson, Oskar Cohen, Jacqueline Mallory Karlstad, Øystein Cesta, Carolyn E. Bjørk, Marte-Helene Håberg, Siri Eldevik Einarsdottir, Kristjana Furu, Kari Gissler, Mika Hjellvik, Vidar Kieler, Helle Leinonen, Maarit Nørgaard, Mette Essen, Buket Öztürk Ulrichsen, Sinna Pilgaard Reutfors, Johan Zoega, Helga |
spellingShingle |
Halfdanarson, Oskar Cohen, Jacqueline Mallory Karlstad, Øystein Cesta, Carolyn E. Bjørk, Marte-Helene Håberg, Siri Eldevik Einarsdottir, Kristjana Furu, Kari Gissler, Mika Hjellvik, Vidar Kieler, Helle Leinonen, Maarit Nørgaard, Mette Essen, Buket Öztürk Ulrichsen, Sinna Pilgaard Reutfors, Johan Zoega, Helga Antipsychotic use in pregnancy and risk of attention/deficit-hyperactivity disorder and autism spectrum disorder: a Nordic cohort study |
author_facet |
Halfdanarson, Oskar Cohen, Jacqueline Mallory Karlstad, Øystein Cesta, Carolyn E. Bjørk, Marte-Helene Håberg, Siri Eldevik Einarsdottir, Kristjana Furu, Kari Gissler, Mika Hjellvik, Vidar Kieler, Helle Leinonen, Maarit Nørgaard, Mette Essen, Buket Öztürk Ulrichsen, Sinna Pilgaard Reutfors, Johan Zoega, Helga |
author_sort |
Halfdanarson, Oskar |
title |
Antipsychotic use in pregnancy and risk of attention/deficit-hyperactivity disorder and autism spectrum disorder: a Nordic cohort study |
title_short |
Antipsychotic use in pregnancy and risk of attention/deficit-hyperactivity disorder and autism spectrum disorder: a Nordic cohort study |
title_full |
Antipsychotic use in pregnancy and risk of attention/deficit-hyperactivity disorder and autism spectrum disorder: a Nordic cohort study |
title_fullStr |
Antipsychotic use in pregnancy and risk of attention/deficit-hyperactivity disorder and autism spectrum disorder: a Nordic cohort study |
title_full_unstemmed |
Antipsychotic use in pregnancy and risk of attention/deficit-hyperactivity disorder and autism spectrum disorder: a Nordic cohort study |
title_sort |
antipsychotic use in pregnancy and risk of attention/deficit-hyperactivity disorder and autism spectrum disorder: a nordic cohort study |
publishDate |
2021 |
url |
https://hdl.handle.net/11250/2838582 https://doi.org/10.1136/ebmental-2021-300311 |
geographic |
Norway |
geographic_facet |
Norway |
genre |
Iceland |
genre_facet |
Iceland |
op_source |
1-9 Evidence-Based Mental Health |
op_relation |
Norges forskningsråd: 262700 Evidence-Based Mental Health. 2021, 1-9. urn:issn:1362-0347 https://hdl.handle.net/11250/2838582 https://doi.org/10.1136/ebmental-2021-300311 cristin:1985643 |
op_doi |
https://doi.org/10.1136/ebmental-2021-300311 |
container_title |
Evidence Based Mental Health |
container_start_page |
ebmental-2021-30 |
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1766042772264976384 |