Dangers Associated with ADHD Stimulant Use During Pregnancy Are Small, Study Finds
Women who continue to use amphetamine or methylphenidate during part or all of their pregnancies face a slightly increased risk of premature labor and delivery, and of preeclampsia. These risks, however, may be smaller than those associated with ceasing ADHD treatment for some expectant mothers, the authors of a new study suggest.
November 29, 2017
The risks associated with taking an ADHD stimulant medication during pregnancy are real, but quite small, according to a large population-based study1 recently published in the journal Obstetrics & Gynecology. The research shows that women who took ADHD stimulants during pregnancy experienced a slightly increased risk of preterm birth or preeclampsia — a potentially dangerous complication characterized by high blood pressure. However, the absolute risks of each condition were small, which lead the study authors to suggest that women with severe ADHD discuss with their doctors the pros and cons of stimulant use during pregnancy before writing off the option entirely.
The study evaluated more than 1.4 million U.S. Medicaid enrollees who had been pregnant between the year 2000 and 2010. The vast majority of these women served as controls; only approximately 5,000 had taken amphetamine, methylphenidate, or atomoxetine during the beginning weeks of their pregnancy. While about 3,500 of those women discontinued their medication at or before the 20-week mark, the remaining women continued to take their medication throughout the course of their pregnancies.
Women who took stimulants during the early stages of their pregnancy had 1.29 times the chance of developing preeclampsia, the researchers found; they were also 1.06 times as likely to give birth prematurely. Women who continued their stimulant medication past 20 weeks were 1.3 times as likely to have a preterm birth, but showed a slightly lower risk for preeclampsia (1.26 times). Atomoxetine, a nonstimulant medication, was not associated with any adverse outcomes in children.
The risks of adverse effects from ADHD medication use during pregnancy are fairly small, the researchers note. Still, they may cause women with ADHD to cease taking stimulant medication during pregnancy — a decision that, in the authors’ view, may not be wholly necessary.
“The increases in risk identified do not warrant abstaining from critical treatment,” said lead author Jacqueline Cohen, Ph.D., in an interview with Medscape Medical News. “It is important to balance the benefits of treatment, which may improve functioning, including maintaining family relationships, adherence to prenatal care, and avoidance of substance abuse.”
Other experts disagreed. “The results can’t at this point be generalized to a population at large,” said Sue Varma, M.D., who was not involved in the study. Given the existing risks, “I would want to understand what is the mother’s baseline level of functioning,” she said. “Ideally, I would recommend a taper off the medication, if possible.”
1 Cohen, Jacqueline M., et al. “Placental Complications Associated With Psychostimulant Use in Pregnancy.” Obstetrics & Gynecology, vol. 130, no. 6, 2017, pp. 1192–1201., doi:10.1097/aog.0000000000002362.