(271) Discontinuation patterns of antipsychotics in pregnant women: A cohort study from South Korea

Background: The use of antipsychotics during pregnancy could have negative effects on the offspring, but abrupt discontinuation of medication treatment can lead to the exacerbation of symptoms or relapse. Several studies have reported that many patients with schizophrenia discontinue antipsychotics during pregnancy, however, data on Asian women is lacking.

Objectives: This study aimed to describe the discontinuation patterns of antipsychotics among schizophrenia patients during pregnancy.

Methods: We conducted a retrospective cohort study using the 2011–2020 Health Insurance Review and Assessment database. The pregnancy cohort included individuals who had 1 or more live births and received a diagnosis of schizophrenia with antipsychotic prescriptions within 180 days before pregnancy. The non-pregnancy cohort, with no record of delivery, miscarriage, or abortion, was matched 1:2 to the pregnancy cohort based on age and the date of antipsychotic prescription. The discontinuation of antipsychotics was defined as an interval of >30 days between the end of previous antipsychotic exposure and the date of the next antipsychotic prescription. We used the Kaplan-Meier method to assess antipsychotic discontinuation incidence. The Cox proportional hazards model estimated hazard ratios (HR) and 95% confidence intervals (CI) associated with discontinuation of antipsychotics according to the characteristics.

Results: We identified 2,066 delivery episodes in 1,930 women. Among the pregnancy cohort, 17.9% were 15–29 years old, 73.2% were 30–39, and 8.9% were 40–49. During pregnancy, 75.9% of the pregnancy cohort discontinued antipsychotics before delivery, compared with 29.7% of the non-pregnancy cohort. Additionally, 67.5% of the pregnancy cohort discontinued antipsychotics by the first trimester. Compared to women aged 30–34, those aged 40–49 had a lower risk of discontinuation (adjusted HR: 0.68, CI: 0.55–0.86), while women aged 25–29 had a higher risk (adjusted HR: 1.24, CI: 1.06–1.46). Compared to women on atypical antipsychotics alone, those on long-acting injectable antipsychotics had a lower risk of discontinuation (adjusted HR: 0.43, CI: 0.27–0.67). Women who used antipsychotics for 61–120 days (adjusted HR: 0.69, CI: 0.56–0.86) or more than 120 days (adjusted HR: 0.19, CI: 0.15–0.23) before pregnancy had a lower risk compared to those who used them for less than 60 days.

Conclusions: Our study highlights most pregnant women discontinued antipsychotics by the end of the first trimester. This discontinuation was notably influenced by the type of antipsychotic prescribed, the duration of antipsychotics before pregnancy, and maternal age. These findings offer the valuable insights into the management of patients with schizophrenia during pregnancy.