ADHD medication in pregnancy linked to few absolute increased risks

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Data suggest that the absolute increases in risks associated with psychostimulant use in women with ADHD are small.
Data suggest that the absolute increases in risks associated with psychostimulant use in women with ADHD are small.

Although psychostimulant use during pregnancy was associated with a small increase in relative risk of preeclampsia and preterm birth, the absolute increased risks are small according to a study published in Obstetrics & Gynecology.  As a result, Jacqueline M. Cohen, PhD, of the Harvard T.H. Chan School of Public Health, Boston, Massachusetts, and colleagues argue that women with significant attention-deficit/hyperactivity disorder (ADHD) should not be counseled to interrupt ADHD treatment.

This population-based cohort study evaluated pregnant women enrolled in Medicaid from 2000 to 2010. Patients who received amphetamine-dextroamphetamine or methylphenidate monotherapy during the first half of pregnancy were compared with unexposed patients. Atomoxetine, which is a nonstimulant ADHD medication, was considered a negative control exposure.  Women who continued stimulant monotherapy after 20 weeks of gestation were compared with women who discontinued the medication.

Pregnant women receiving amphetamine-dextroamphetamine (n=3331), methylphenidate (n=1515), and atomoxetine (n=453) therapy in early pregnancy were compared with 1,461,493 unexposed pregnant women. While 3,527 women discontinued stimulant therapy at or before 20 weeks, 1,319 continued stimulant use in the latter half of pregnancy.

The adjusted risk ratio for stimulant use compared with nonexposed women was 1.29 for preeclampsia, 1.13 for placental abruption, 0.91 for small or gestational age, and 1.06 for preterm birth. Compared with discontinuation, continuation of stimulant use in the latter half of pregnancy had an adjusted risk ratio of 1.26 for preeclampsia, 1.08 for placental abruption, 1.37 for small for gestational age, and 1.30 for preterm birth. Atomoxetine was not associated with these adverse pregnancy outcomes.

Confounding factors are a concern in observational studies, but the investigators controlled for many psychiatric and physical conditions and comedication use, which may be correlated with ADHD, smoking, and obesity. These data suggest that the absolute increases in risks associated with stimulant use in women with ADHD are small.

Reference

Cohen JM, Hernandez-Diaz S, Bateman BT, et al. Placental complications associated with psychostimulant use in pregnancy [published online November 3, 2017]. Obstet Gynecol. doi:10.1097/AOG.0000000000002363

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