BACKGROUND We have limited knowledge about the effects of antipsychotic exposure on the development of gestational diabetes mellitus (GDM). Aim of this study is to perform a systematic review and meta-analysis to assess GDM risk associated with antipsychotic exposure in pregnancy. METHODS Systematic literature search was performed using PubMed, Science Direct, Scopus, and Web of Science databases up to August 22, 2018. No restrictions to language or date were applied. Randomized, controlled trials, case-control, or cohort studies reporting GDM risk in antipsychotic-exposed, healthy controls or antipsychotic-ceased patients were included in the meta-analysis. The primary outcomes were study defined GDM, including number of events, odds ratios, and/or risk ratios (RR) with confidence intervals (CI). RESULTS Ten studies were included in the meta-analysis. The total number of subjects was 6213 for the antipsychotic-exposed group, 6836 for antipsychotic-ceased control group, and 1 677 087 for the healthy control group. Compared with the healthy controls, the unadjusted cumulative RR for GDM associated with antipsychotic use was 1.63 (95% CI = 1.20-2.22). Adjusted risk for GDM was significantly higher in antipsychotic exposure group than in healthy controls (RR = 1.30, 95% CI = 1.023-1.660). The adjusted RR for GDM was similar between the antipsychotic-exposed group and the antipsychotic-ceased group (RR = 0.78, 95% CI = 0.281-2.164). No significant association was found between study quality, smoking, alcohol use, gestational age, and cumulative GDM risk. DISCUSSION Our results indicate an increased risk of GDM with antipsychotic exposure in pregnant women, who may benefit from close pregnancy monitoring, early testing for GDM, targeting modifiable risk factors, and lifestyle modifications.

中文翻译：

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妊娠期抗精神病药的暴露和妊娠糖尿病的风险：系统评价和荟萃分析。

背景技术我们对抗精神病药暴露对妊娠糖尿病（GDM）的发展了解有限。这项研究的目的是进行系统的审查和荟萃分析，以评估妊娠期与抗精神病药相关的GDM风险。方法截至2018年8月22日，使用PubMed，Science Direct，Scopus和Web of Science数据库进行系统的文献检索。不对语言或日期进行限制。荟萃分析中包括随机，对照试验，病例对照研究或队列研究，这些研究报告了抗精神病药，健康对照或抗精神病药导致的患者中存在GDM风险。主要结果是研究定义的GDM，包括事件数，优势比和/或具有置信区间（CI）的风险比（RR）。结果荟萃分析包括十项研究。抗精神病药暴露组的受试者总数为6213，抗精神病药停止的对照组的受试者总数为6836，健康对照组的受试者总数为1 677 087。与健康对照相比，与抗精神病药物使用相关的GDM的未经调整的累积RR为1.63（95％CI = 1.20-2.22）。抗精神病药暴露组的GDM调整后风险显着高于健康对照组（RR = 1.30，95％CI = 1.023-1.660）。在抗精神病药暴露组和抗精神病药停止组之间，GDM的调整后RR相似（RR = 0.78，95％CI = 0.281-2.164）。在研究质量，吸烟，饮酒，胎龄和累积GDM风险之间未发现显着关联。