Study: Girls with ADHD Face Increased Risk for Teen Pregnancy
Teenagers with ADHD face an increased risk for early pregnancy, according to a new study in Taiwan. However, long-term use of ADHD medications does reduce the risk for teen pregnancies.
February 12, 2020
Girls with ADHD face an increased risk for teen pregnancy compared to their neurotypical peers, according to a new study conducted in Taiwan, which also suggests that long-term medication use could reduce the risk for early pregnancy among teens with ADHD by 34 percent.1
Published in the Journal of Attention Disorders, this nation-wide, longitudinal study found that teenagers with ADHD were more than twice as likely to become pregnant before age 20 and experience more pregnancies than their neurotypical peers.1 Researchers from Taipei Veterans General Hospital and National Yang-Ming University also studied pregnancies in women with and without ADHD before the age of 30, and found that long-term ADHD medication use decreases this likelihood of early pregnancy.1
To assess a large sample size, researchers collected data from the Taiwan National Health Insurance Research Database (NHIRD), which provides researchers access to health care data from 99% of Taiwan’s population. All individual records are anonymous to protect patient privacy. In total, this study evaluated 7,505 adolescents with ADHD and 30,020 controls without ADHD, matched by age and sex.1
To qualify for the ADHD group, participants needed to receive an ADHD diagnosis (ICD-9-CM Code: 314) from a board-certified psychiatrist between 2001 and 2009. Participants ranged in age from 10 to 19 and did not have any history of a prior pregnancy. Researchers followed up with the medical records of these patients for a maximum of 11 years.1
In order to examine the impact of medication use on risk for early or any subsequent pregnancy, researchers divided participants with ADHD into three groups: ‘nonusers’ who tried medicine for less than 30 days; ‘short-term users’ who took medicine between 30 and 179 days; and ‘long-term users’ who used medication longer than 180 days. Methylphenidate and atomoxetine are the only ADHD medications approved to treat ADHD in Taiwan.1 Researchers found that only 26% of participants qualified as long-term users of ADHD medication, whereas 46% of the patients with ADHD did not receive medication at all.1
The study found that participants with ADHD became pregnant younger, more frequently, and had a higher risk for early pregnancy than did their non-ADHD counterparts.1 Overall, 3.2% of teens with ADHD became pregnant before age 20, whereas only 1.4% of teens without ADHD experienced early pregnancy.1
Furthermore, the results of the study indicate that long-term use of ADHD medication lowers the risk of early pregnancy and any pregnancy by 34% and 30%, respectively.1 While the outcomes of long-term medication use seem hopeful, researchers did not find an association between short-term medication use and reduced rates of early or any pregnancy. In fact, the rate of pregnancy in the group of adolescents who engaged in short-term medication use did not significantly differ from the group taking no medication. These findings suggest that use of ADHD medication could decrease the risk for early pregnancy only if taken for longer than 180 days. More research needs to be dedicated towards investigating this potential risk-reduction treatment.1
Additionally, individuals exhibiting ADHD and psychiatric comorbidities had the highest risk for subsequent pregnancy.1 Disruptive behavior disorders — not substance and alcohol use disorders — played the largest role of all the comorbidities in increasing the risk for early pregnancy. Though researchers need more research to determine exactly how comorbidities impact this risk, this study offers support for the theory that ADHD is an independent risk factor for subsequent early pregnancy.1
Other studies have investigated the same theory. One recent study from Sweden, published in the Journal of the American Medical Association in October 2019, revealed that girls with ADHD are 6.2 times more likely to become mothers during their teenage years than are their non-ADHD counterparts.2 A clinical neuroscientist at the Karolinska Institute in Sweden and the lead author of this study, Charlotte Borg Skoglund, M.D., Ph.D., commented, “Underlying difficulties associated with ADHD such as executive problems, impulsivity, and risk-taking behaviors are probably part of the explanation of why girls and young women with ADHD are at such high risk for becoming mothers at such a young age,” echoing the assumptions of the January 2020 Taiwan-based study.3 More research will help determine the exact underlying nature of this risk.
In response to the findings of the Sweden-based study, Eugene Arnold, M.D, MEd, professor emeritus of psychiatry and behavioral sciences at Ohio State University, adds that he suspects troubles with remembering contraception — like taking a daily pill or carrying around condoms — contribute to the increased risk for teenage pregnancies among girls with ADHD.4 Arnold advises concerned parents to consult with their daughter’s gynecologist about the possibility of utilizing contraceptive devices that don’t require daily maintenance, such as IUDs or implants.4
Likewise, the researchers of the Taiwan-based study from APSARD offer advice for worried clinicians, researchers, and parents. Backed by the findings of their study, the researchers “propose that long-term ADHD treatment reduces the risk of any pregnancy and [early pregnancy] both directly by reducing impulsivity and risky sexual behaviors and indirectly by lowering risk and severity of the associated comorbidities, such as disruptive behavior and substance use disorders.”1
80 percent of early pregnancies are unexpected, and reducing the impact of early pregnancies has been a major objective for public health agencies.1 The U.S. Department of Health and Human Services’ national campaign, Healthy People 2020, identifies “[improving] pregnancy planning and spacing, and [preventing] unintended pregnancy” as a key public health objective.5 Thus, it is critical for researchers, health care providers, parents, government officials, and individuals with ADHD to consider how ADHD is a risk factor for early, unintended, or any pregnancy.
1Hua, M.-H., Huang, K.-L., Hsu, J.-W., Bai, Y.-M., Su, T.-P., Tsai, S.-J., … Chen, M.-H. (2020). Early Pregnancy Risk Among Adolescents With ADHD: A Nationwide Longitudinal Study. Journal of Attention Disorders. https://doi.org/10.1177/1087054719900232
2Skoglund C, Kopp Kallner H, Skalkidou A, et al. Association of Attention-Deficit/Hyperactivity Disorder With Teenage Birth Among Women and Girls in Sweden. JAMA Netw Open. 2019;2(10):e1912463. doi:10.1001/jamanetworkopen.2019.12463
3Zimlich, R., RN, BSN. (2019, October 23). Girls with ADHD at increased risk for teen pregnancy. Retrieved February 11, 2020, from https://www.contemporarypediatrics.com/adhd/girls-adhd-increased-risk-teen-pregnancy
4Thompson, D. (2019, October 02). Pregnancy much more likely for teen girls with ADHD. Retrieved February 11, 2020, from https://www.usnews.com/news/health-news/articles/2019-10-02/pregnancy-much-more-likely-for-teen-girls-with-adhd
5Family planning. (2014). Retrieved February 11, 2020, from https://www.healthypeople.gov/2020/topics-objectives/topic/family-planning