Monday, November 13, 2017

ADHD Medication Use During Pregnancy Poses Modest Birth Risks

The use of attention-deficit/hyperactivity disorder (ADHD) medications during pregnancy can modestly increase the risk of some negative birth outcomes, according to a study published Friday in Pediatrics

Ulrika Nörby, Ph.D., of Lund University in Sweden and colleagues found that infants exposed to ADHD medications during pregnancy were about 50% more likely of being admitted to a neonatal intensive care unit (NICU) than infants whose mothers never took these medications and about 20% more likely to require care in a NICU than infants whose mothers used these medications before or after but not during pregnancy.

Infants exposed to ADHD medications in utero were also more likely to experience central nervous system–related disorders such as seizures (odds ratio=1.9) and were more often born preterm (odds ratio=1.3) compared with infants who were not exposed to these medications. 

“These findings warrant attention but are hardly reasons to abstain from ADHD medication during pregnancy if treatment is crucial for the woman,” Nörby and colleagues wrote. “Because women who used these drugs during pregnancy in many ways differed from the average pregnant population, it is uncertain to what extent these associations can be explained by the ADHD medication itself.” 

Nörby and colleagues analyzed data from Swedish birth and medical registries, including nearly one million single births recorded between July 1, 2006, and December 31, 2014. They identified 1,591 infants (0.2%) who were exposed to ADHD medication during pregnancy (1,464 were exposed to stimulants and 165 were exposed to atomoxetine).

“Despite the authors’ effort to control possible confounding by using a comparison group who carried a diagnosis of ADHD, it is an imperfect control condition,” Kimberly Yonkers, M.D., a professor of psychiatry, epidemiology, and obstetrics, gynecology, and reproductive sciences at Yale University, told Psychiatric News. “Women who used ADHD medication were clearly different in many ways from the other two groups.” 

Yonkers added that the authors did not have information related to the use of illicit substances and alcohol in these women, which could be a contributing factor. She noted that the study found women taking ADHD medications reported much higher levels of nicotine use than those who did not, so it is possible that other substance use by this group was higher as well.

To read more about mental health and pregnancy, see the Psychiatric News PsychoPharm article “Yes or No: Prescribing Antidepressants to Pregnant Patients” by Jennifer L. Payne, M.D., and the American Journal of Psychiatry article “ADHD and Pregnancy” by Marlene P. Freeman, M.D.

(Image: iStock/Halfpoint)


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