Pregnancy exposure to second-generation antipsychotics and the risk of gestational diabetes

Assessment of the metabolic safety of second-generation antipsychotics (SGAs) is mandatory in pregnant women, where the occurrence of metabolic complications and, especially, gestational diabetes mellitus (GDM) may severely impact on pregnancy and fetal outcomes.

The aim of this article is to review published data reporting the occurrence of GDM during SGA treatment, and to establish whether or not this iatrogenic complication is a relevant concern in clinical practice. Medical literature information published in any language since 1996 was identified using MEDLINE/PubMed, EMBASE, Scopus, and The Cochrane Library. All articles reporting metabolic complications in pregnancies exposed to single, specific SGAs were acquired, without methodological or language limitations.

Among studies assessing the metabolic safety of specific SGAs, we have 18 cases of GDM overall: 5 cases involve clozapine (CLO), 9 olanzapine (OLA) - the SGA agent that shows the highest number of reported cases of pregnancy exposure - and 2 each for quetiapine and risperidone. Four of these cases, 2 involving CLO and 2 OLA, were complicated by serious fetal and/or neonatal consequences. Such reports of SGA-associated GDM, together with preliminary data coming from retrospective and prospective studies, may represent signals of a potential safety issue.