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Updated: Jun 11, 2025

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Neonatal outcomes after in utero exposure to antipsychotics: a systematic review and meta-analysis

Kristen Joseph-Delaffon1, Lina Eletri2, Agnès Dechartres3

  • 1Département de Santé Publique, Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpital Trousseau, Centre de Référence sur les Agents Tératogènes (CRAT), Paris, F75012, France.

European Journal of Epidemiology
|October 1, 2024
PubMed

Insights

Antipsychotic use during pregnancy may pose risks to newborns, with first-generation drugs linked to smaller babies and second-generation drugs to larger babies. Both types increased risks of preterm birth and hospitalization.

Area of Science:

  • Perinatal psychiatry
  • Neonatal outcomes research
  • Systematic review and meta-analysis

Background:

  • Clarity on adverse neonatal outcomes from in utero antipsychotic exposure is limited.
  • This study systematically reviewed and meta-analyzed associations between first- and second-generation antipsychotic exposure and neonatal outcomes.

Approach:

  • Searched multiple databases (MEDLINE, EMBASE, CENTRAL, ICTRP, ClinicalTrials.gov) up to July 2023.
  • Included 31 observational studies, assessing risk of bias using ROBINS-I.
  • Performed meta-analyses to determine odds ratios and mean differences for various neonatal outcomes.

Key Points:

  • First-generation antipsychotics were associated with increased risk of small for gestational age (<3rd percentile) and lower mean birthweight.
  • Second-generation antipsychotics were linked to large for gestational age (>97th percentile) and low Apgar scores (<7).
  • Both antipsychotic classes showed increased risks of preterm birth and neonatal hospitalization.

Conclusions:

  • Newborns exposed to antipsychotics in utero may be at risk for adverse outcomes, including birth weight alterations, prematurity, and hospitalization.
  • Potential confounding factors in observational studies warrant consideration.
  • Further research is needed to fully elucidate the risks associated with prenatal antipsychotic exposure.

Keywords:
AntipsychoticsLarge for gestational ageNeonatalPregnancyPretermSmall for gestational age

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