Exposure to antidepressant and antipsychotic medicines in pregnant women and risk of gestational diabetes: a systematic review and meta-analysis of observational studies.

In 30 seconds

This systematic review and meta-analysis pooled observational studies of gestational diabetes mellitus (GDM) among pregnant women exposed to antidepressants or antipsychotics. Across 21 studies, prenatal exposure was associated with higher GDM risk: the pooled adjusted relative risk was 1.43 (95% CI: 1.17,1.69) for antipsychotics and 1.19 (95% CI: 1.10,1.27) for antidepressants. Second-generation antipsychotics were associated with a significantly higher risk (RR = 1.6, 95% CI: 1.23, 1.97), whereas first-generation antipsychotics showed no statistically significant association. Because the evidence came from observational studies, these findings indicate associations rather than causation.

Key findings

• Across 21 studies, antipsychotic exposure was associated with GDM risk of 1.43 (95% CI: 1.17,1.69).
• Antidepressant exposure was associated with GDM risk of 1.19 (95% CI: 1.10,1.27).
• Second-generation antipsychotics were associated with higher GDM risk (RR = 1.6, 95% CI: 1.23, 1.97); first-generation antipsychotics showed no statistically significant association.

Why it matters

GDM is a relevant metabolic outcome when psychotropic medicines are used during pregnancy. The pooled associations, particularly for second-generation antipsychotics, highlight a potential risk to weigh alongside the need to manage severe mental illness. Observational evidence cannot establish that medication exposure causes GDM, so the findings inform risk awareness rather than proving a medication effect.

What to keep in mind

The evidence is observational, so residual confounding and other differences between exposed and unexposed women may contribute to the associations.