ADHD medications in pregnancy may increase risk of infantile morbidity

1. Infants born to mothers who used medications for treatment of attention-deficit/hyperactivity disorder (ADHD) during pregnancy had increased risk of central nervous system (CNS) disorders, prematurity, and admission to the neonatal intensive care unit (NICU).

2. ADHD medication use during pregnancy was not associated with increased risk of neonatal mortality or congenital malformations.

Evidence Level: 2 (Good)

Study Rundown: In the United States, ADHD medications, including stimulants and atomoxetine, are used by approximately 1% of women during pregnancy. Despite being one of the most frequently prescribed medications among pregnant women, little evidence exists on the effect of antepartum stimulant use on perinatal outcomes. Authors of this study compared neonatal morbidity and mortality among infants born to mothers who either used their ADHD medications during pregnancy or did not use ADHD medications, as well as to mothers who were exposed only before and after pregnancy. Results showed neonates whose mothers continued medication use during pregnancy had higher rates of NICU admission and CNS disorders, compared to infants in the other 2 groups. These rates were similar even after excluding mothers who used atomoxetine (non-stimulant) only. Antepartum maternal ADHD medication use also increased risk of prematurity and being large for gestational age, compared to neonates whose mothers had no medication use. One limitation of this study is the potential of confounding from other factors that were significantly higher among women who continued ADHD medication use during pregnancy, including use of other psychoactive prescription medications, younger age, smoking, and obesity. Nonetheless, the findings from this study should be considered by psychiatrists and other physicians managing ADHD medications among pregnant women.

Click to read the study, published today in Pediatrics

Relevant reading: Increasing use of ADHD medications in pregnancy

In-depth [retrospective cohort]: Participants in this study included live singleton births that occurred in Sweden between 2006 and 2014. Using several data registries, researchers collected data on maternal demographics, pregnancy course, and drug use, as well as data on perinatal outcomes from 964,734 births (1591 ADHD medications during pregnancy, 9475 medications before or after pregnancy, and 953,668 no medication use). Results showed that exposure to ADHD medications (both stimulants and atomexitine) during pregnancy was associated with higher rates of NICU admission (aOR 1.5, 95% CI 1.3-1.7 and aOR 1.2, 95% CI 1.1-1.4 for no medication use and use before or after pregnancy, respectively) and of neonatal CNS disorders (aOR 1.9, 95% CI 1.1-3.1 and aOR 1.8, 95% CI 1.0-3.3 for no medication use and medication use before or after pregnancy, respectively). These rates were similar even after excluding mothers whose used atomoxetine rather than a stimulant medication. Overall, 1.0% of neonates with in utero exposure to ADHD medication (N=16), 0.4% whose mothers used medication before or after pregnancy (N=40) and 0.3% with no ADHD medication exposure (n=2885) experienced CNS-related disorders. Neonates exposed to these medications in utero also showed higher rates of moderately preterm birth and large for gestational age compared to neonates not exposed to these medications (aOR 1.3 (95% CI 1.1–1.6 and aOR 1.3 95% CI, 1.0–1.7, respectively). There was no significant difference in neonatal mortality or frequency of congenital malformations among the groups. Of note, mothers who used ADHD medications during pregnancy differed significantly from mothers who had no ADHD medication use in several ways: they were more likely to be younger, obese, smokers and to have used other neurotropic drugs during pregnancy.

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