Although current prescribing guidelines suggest continuation of psychotropic drugs in pregnant women, population-based evidence supporting their safety is limited.

This study aims to clarify the plausible causal links between maternal psychotropic drug exposures and obstetric complications.

This cohort study investigated all births by Hong Kong residents ≥18 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’s 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.

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 1.46–4.83), and between valproate and low birth weight (odds ratio 1.68, 95% CI 1.16–2.37). These associations became non-significant in negative control analysis, and the high E-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.

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.

Population-wide restrictions during the COVID-19 pandemic may create barriers to mental health diagnosis. This study aims to examine changes in the number of incident cases and the incidence rates of mental health diagnoses during the COVID-19 pandemic.

By using electronic health records from France, Germany, Italy, South Korea and the UK and claims data from the US, this study conducted interrupted time-series analyses to compare the monthly incident cases and the incidence of depressive disorders, anxiety disorders, alcohol misuse or dependence, substance misuse or dependence, bipolar disorders, personality disorders and psychoses diagnoses before (January 2017 to February 2020) and after (April 2020 to the latest available date of each database [up to November 2021]) the introduction of COVID-related restrictions.

A total of 629,712,954 individuals were enrolled across nine databases. Following the introduction of restrictions, an immediate decline was observed in the number of incident cases of all mental health diagnoses in the US (rate ratios (RRs) ranged from 0.005 to 0.677) and in the incidence of all conditions in France, Germany, Italy and the US (RRs ranged from 0.002 to 0.422). In the UK, significant reductions were only observed in common mental illnesses. The number of incident cases and the incidence began to return to or exceed pre-pandemic levels in most countries from mid-2020 through 2021.

Healthcare providers should be prepared to deliver service adaptations to mitigate burdens directly or indirectly caused by delays in the diagnosis and treatment of mental health conditions.