Continuing stimulants or switching to atomoxetine during pregnancy was associated with differing health risks to the mother and child, according to a study issued by Psychiatric Research and Clinical Practice.Why It’s Relevant
An increasing number of women are prescribed stimulants or atomoxetine during childbearing years, but studies of their impact on pregnancy outcomes have yielded conflicting results. In addition, there are no definitive guidelines or clear clinical recommendations for the use of these medications in pregnancy.
By the Numbers
- Among 32,152 pregnant adults prescribed stimulants at least twice prior to pregnancy, 26% continued stimulants, 1% were switched to atomoxetine, and 73% received neither medication during pregnancy.
- Compared with women taking atomoxetine, those taking stimulants during pregnancy had 35% higher odds of prenatal maternal complications (gestational diabetes, hypertension, or pre-eclampsia/eclampsia) as well as three times the odds of placental complications and miscarriage.
- Compared with atomoxetine, however, stimulant use was associated with 54% lower odds of fetal growth restriction and 31% lower odds of delivery complications (C-section, instrumental delivery, or induced labor).
What’s More
Women taking stimulants had modestly increased risks of maternal, placental, and birth-related outcomes relative to women discontinuing medications. Atomoxetine exposure, on the other hand, was comparable to discontinuing medications when it came to these three categories, but it was also associated with a risk of fetal growth abnormalities and significantly higher risk of induced labor or instrumental delivery.
The Other Side
The higher risk of fetal growth restriction among women prescribed atomoxetine may reflect indication bias, because non‐stimulant therapies tend to be selected for patients with greater psychiatric complexity or substance use histories, which are associated with adverse pregnancy outcomes. The relatively small number of women exposed to atomoxetine may limit statistical power for some outcomes.
Takeaway Message
“Treatment decisions regarding the use of stimulant and atomoxetine medications during pregnancy should carefully balance the benefits of maintaining maternal functioning with the modest but measurable risks to pregnancy outcomes,” the researchers wrote.
Related Information
Source
Wen‐Jan Tuan, et al. Comparative risks of pregnancy complications in women prescribed psychostimulants or atomoxetine during pregnancy following pre‐pregnancy stimulant use. Psychiatric Research and Clinical Practice. Published July 21, 2026. doi:10.1176/appi.prcp.20250149
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