Antipsychotic use during pregnancy and risk of gestational diabetes: an updated meta-analysis

Gestational diabetes mellitus (GDM) is a pregnancy-onset diabetes with diverse global rates, impacting maternal and infant health and offspring's long-term well-being. The potential link between antipsychotic medication uses during pregnancy and GDM risk is a contentious issue.

We conducted an updated meta-analysis to assess the risk of GDM associated with antipsychotic medication use during pregnancy. Our comprehensive literature search covered the period from January 1990 to December 2024, identifying observational studies that explored the relationship between antipsychotic use and GDM risk. The meta-analysis included 11 studies involving 11,665 women exposed to antipsychotic medications and 2,978,769 unexposed women.

The analysis revealed a significant positive correlation between the use of antipsychotics and the risk of GDM, with an OR of 1.33 (95 % Confidence Interval CI = 1.22-1.44; P < 0.001). Subgroup analyses indicated no increased GDM risk with FGAs, but a 1.4 times higher risk with SGAs. The risk of GDM associated with antipsychotic use was similar in both the general pregnant population and pregnant women with psychiatric disorders.

The updated meta-analysis suggests a significant association between antipsychotic medication use during pregnancy and an increased risk of GDM, particularly with SGAs. These findings highlight the importance of metabolic monitoring for pregnant women on antipsychotic medications and call for further research to clarify the mechanisms underlying this association and to guide clinical management of pregnant women with psychiatric disorders.