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Obstetric Outcomes With Second-Generation Long-Acting Injectable Versus Oral Antipsychotics
Farah Khorassani1, Gemma Espejo2, Kelly C Lee3,4
1Department of Clinical Pharmacy Practice, University of California, Irvine School of Pharmacy and Pharmaceutical Sciences, Irvine, California.
The Journal of Clinical Psychiatry
|December 15, 2025
Summary
Pregnant women using second-generation long-acting injectable antipsychotics (LAIAs) or oral antipsychotics had similar obstetric outcomes, including gestational diabetes and hypertensive disorders. Cesarean section rates were also comparable between the groups.
Area of Science:
- Obstetrics and Gynecology
- Psychiatry
- Pharmacology
Background:
- Second-generation antipsychotics are used to manage psychiatric conditions in pregnant women.
- Long-acting injectable antipsychotics (LAIAs) offer an alternative administration route to oral formulations.
- Limited data exists on the comparative obstetric safety of LAIAs versus oral second-generation antipsychotics.
Purpose of the Study:
- To compare obstetric outcomes in pregnant patients exposed to second-generation LAIAs versus second-generation oral antipsychotics.
- To evaluate the incidence of gestational diabetes, preeclampsia, eclampsia, and new hypertensive disorders.
- To assess cesarean section rates in the two treatment groups.
Main Methods:
- Retrospective study using the TriNetX database across 148 health care organizations.
- Two cohorts were created: pregnant patients exposed to long-acting aripiprazole, risperidone, paliperidone, or olanzapine (n=2,082) and those exposed to oral formulations (n=31,376).
- Propensity score matching was employed, with primary outcomes including composite obstetric complications and cesarean section rates.
Main Results:
- After propensity matching, 2,025 patients were in each cohort.
- No significant differences were observed in the composite primary endpoint (gestational diabetes, preeclampsia, eclampsia, hypertensive disorders) between the LAIA and oral antipsychotic groups (OR 0.95; 95% CI, 0.76-1.18; P=.61).
- Cesarean section rates were also similar between the groups.
Conclusions:
- Second-generation long-acting injectable antipsychotics (LAIAs) and oral antipsychotics demonstrate comparable safety profiles regarding major obstetric complications.
- These findings support the use of LAIAs in pregnant patients when clinically indicated, with similar risks of gestational diabetes, hypertensive disorders, and cesarean delivery.
- Further research may explore specific LAIA agents and long-term neonatal outcomes.
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