Does Taking Antipsychotic Medication During Pregnancy Increase the Risk of ADHD or Autism in Children?

What you need to know

• This large study of over 4 million children found little evidence that taking antipsychotic medication during pregnancy increases the risk of ADHD or autism in children.
• The mother’s underlying mental health conditions, rather than antipsychotic use itself, appear to be more strongly linked to children’s risk of these neurodevelopmental disorders.
• The findings are reassuring for women who need antipsychotic treatment during pregnancy, though decisions should still be made on an individual basis with a doctor.

The safety of antipsychotics during pregnancy

Antipsychotic medications are primarily used to treat conditions like schizophrenia and bipolar disorder. However, they are increasingly prescribed for other conditions as well, including anxiety, depression, and nausea. As more women of childbearing age are taking these medications, there is growing interest in understanding their safety during pregnancy.

While some studies have looked at the short-term effects of antipsychotic exposure before birth, less is known about potential long-term impacts on children’s development. This study aimed to examine whether exposure to antipsychotics in the womb is associated with higher rates of attention-deficit/hyperactivity disorder (ADHD) or autism spectrum disorder (ASD) in children.

A large Nordic study

Researchers used data from national health registries in Denmark, Finland, Iceland, Norway, and Sweden to conduct one of the largest studies on this topic to date. They identified over 4.3 million children born between 1996 and 2017, following them for an average of 10 years.

The study compared rates of ADHD and ASD diagnoses between children whose mothers filled prescriptions for antipsychotics during pregnancy (about 15,500 children) and those whose mothers did not use these medications while pregnant (over 4.3 million children).

Importantly, the researchers accounted for many factors that could influence results, including the mother’s:

• Age
• Education level
• Other health conditions
• Use of other medications
• Psychiatric diagnoses

They also conducted analyses comparing siblings and looking at different patterns of antipsychotic use before and during pregnancy.

Key findings

After accounting for other factors, the study found:

• Children exposed to antipsychotics before birth had a 10% higher rate of ADHD diagnosis compared to unexposed children. However, this small increase was not statistically significant, meaning it could be due to chance.
• For autism, there was a 12% higher rate in exposed children, which was also not statistically significant.
• The timing of antipsychotic use during pregnancy (early vs. late) did not meaningfully change the results.
• When comparing siblings where one was exposed to antipsychotics before birth and the other was not, there were no significant differences in ADHD or autism rates.

The role of maternal mental health

Importantly, the study found that a mother’s underlying mental health conditions were more strongly linked to children’s risk of ADHD and autism than antipsychotic use itself:

• Children whose mothers had psychotic or bipolar disorders but did not use antipsychotics during pregnancy had about 80% higher rates of ADHD and 90% higher rates of autism compared to children of mothers without these conditions.
• This suggests that genetic factors or other aspects of living with a parent with severe mental illness may play a larger role than medication exposure.

Interpreting the results

While the study found slightly higher rates of ADHD and autism in children exposed to antipsychotics before birth, these increases were small and could be explained by other factors. The lack of significant differences when comparing siblings provides further reassurance that the medications themselves may not be driving increased risk.

It’s important to note that women who take antipsychotics during pregnancy may differ from those who don’t in ways that are difficult to fully account for in a study. For example, they may have more severe psychiatric symptoms or other unmeasured health differences.

Implications for treatment decisions

These findings are generally reassuring for women who need antipsychotic medications during pregnancy. Untreated severe mental illness during pregnancy can have serious consequences for both mother and baby. This study suggests that the benefits of continuing necessary antipsychotic treatment likely outweigh potential risks to children’s neurodevelopment.

However, decisions about medication use during pregnancy should always be made on an individual basis in consultation with a doctor. The risks and benefits can vary depending on the specific medication, dosage, and a woman’s health history.

Conclusions

• This large study found little evidence that antipsychotic use during pregnancy substantially increases children’s risk of developing ADHD or autism.
• A mother’s underlying mental health conditions appear more strongly linked to these outcomes than medication use.
• The findings are reassuring, but medication decisions during pregnancy should still be made individually with medical guidance.