{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T07:49:56Z","timestamp":1792136996861,"version":"4.4.0"},"reference-count":41,"publisher":"Royal College of Psychiatrists","issue":"4","license":[{"start":{"date-parts":[[2025,9,5]],"date-time":"2025-09-05T00:00:00Z","timestamp":1757030400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Br J Psychiatry"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:sec id=\"S0007125025103401_as1\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Although current prescribing guidelines suggest continuation of psychotropic drugs in pregnant women, population-based evidence supporting their safety is limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0007125025103401_as2\">\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>This study aims to clarify the plausible causal links between maternal psychotropic drug exposures and obstetric complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0007125025103401_as3\">\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>This cohort study investigated all births by Hong Kong residents \u226518 years of age in public hospitals between 2004 and 2022. Birth episodes were classified according to whether they were unexposed to psychotropic drugs, exposed but discontinued before conception or exposed during pregnancy. Firth\u2019s penalised logistic regression was employed in all analysis, and negative control analysis was conducted to assess causality. False discovery rate correction and sensitivity analyses were performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0007125025103401_as4\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 587 419 births, 7182 episodes involved psychotropic prescriptions (antipsychotics, antidepressants, anticonvulsants, benzodiazepines) during pregnancy. In broad drug class analysis, all significant associations observed in the exposed group were also observed in negative control analysis (psychotropics discontinued before conception), suggesting that elevated risks could be attributed to unmeasured confounders. Nevertheless, in subclass analyses, certain psychotropic drugs showed increased risks of obstetric complications, i.e. significant associations between atypical antipsychotics and genito-urinary infection (odds ratio 2.70, 95% CI 1.46\u20134.83), and between valproate and low birth weight (odds ratio 1.68, 95% CI 1.16\u20132.37). These associations became non-significant in negative control analysis, and the high\n                      <jats:italic>E<\/jats:italic>\n                      -values (atypical antipsychotics and genito-urinary infection, 4.84; valproate and low birth weight, 2.75) suggested that the results were unlikely to have been driven by unmeasured confounders. Maternal diagnoses of schizophrenia and depression were independently associated with increased risk of obstetric complications, after controlling for the effects of psychotropics.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0007125025103401_as5\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The population-based data and meticulous analyses did not support any clear causal link between broad-class psychotropic exposure during pregnancy and increased risk of obstetric\/neonatal complications. However, some psychotropic subclasses may increase obstetric\/neonatal complications. The limited number of episodes involving discontinuation of some psychotropic subclasses may have resulted in false negative findings in the negative control analysis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1192\/bjp.2025.10340","type":"journal-article","created":{"date-parts":[[2025,9,5]],"date-time":"2025-09-05T08:21:20Z","timestamp":1757060480000},"page":"386-395","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":1,"title":["The effect of prenatal psychotropic drug exposures on obstetric complications: 19-year population-based study"],"prefix":"10.1192","volume":"229","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5292-5641","authenticated-orcid":false,"given":"Perry B. 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Y.","family":"Wong","sequence":"additional","affiliation":[{"name":"The Chinese University of Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1200-9582","authenticated-orcid":false,"given":"Na","family":"Zhan","sequence":"additional","affiliation":[{"name":"The University of Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3218-6925","authenticated-orcid":false,"given":"Marta","family":"Di Forti","sequence":"additional","affiliation":[{"name":"Institute of Psychiatry, Psychology and Neuroscience, King\u2019s College London"},{"name":"South London and Maudsley NHS Foundation Mental Health Trust"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0829-0519","authenticated-orcid":false,"given":"Robin M.","family":"Murray","sequence":"additional","affiliation":[{"name":"Institute of Psychiatry, Psychology and Neuroscience, King\u2019s College London"},{"name":"South London and Maudsley NHS Foundation Mental Health Trust"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7102-833X","authenticated-orcid":false,"given":"Hon-Cheong","family":"So","sequence":"additional","affiliation":[{"name":"The Chinese University of Hong Kong"},{"name":"The Chinese University of Hong Kong"},{"name":"The Chinese University of Hong Kong"},{"name":"The Chinese University of Hong Kong"},{"name":"The Chinese University of Hong Kong"},{"name":"CUHK Shenzhen Research Institute"},{"name":"Kunming Institute of Zoology and The Chinese University of Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2533-7270","authenticated-orcid":false,"given":"Pak C.","family":"Sham","sequence":"additional","affiliation":[{"name":"The University of Hong Kong"},{"name":"The University of Hong Kong"},{"name":"The University of Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9360-6244","authenticated-orcid":false,"given":"Simon S. 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Published by Cambridge University Press on behalf of Royal College of Psychiatrists","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (https:\/\/creativecommons.org\/licenses\/by\/4.0\/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}]}}