Adverse Gestational Outcomes Associated With Attention-Deficit/Hyperactivity Disorder Medication Exposure During Pregnancy.

Abstract

The use of attention-deficit/hyperactivity disorder (ADHD) medications during pregnancy has increased in recent years. An earlier article in this column examined whether psychostimulant medications, used to treated ADHD and related disorders, increase the risk of major congenital malformations in pregnancies with first trimester exposure to these drugs. This article examines whether amphetamines, methylphenidate, and atomoxetine exposure during early and late pregnancy are associated with other adverse gestational outcomes. One large and 4 small studies provided data relevant to the inquiry. In unadjusted analyses, amphetamines and methylphenidate were associated with an increased risk of most of the adverse outcomes under study. However, in analyses adjusted for potential confounds, amphetamine exposure during early pregnancy was associated only with an increased risk of preeclampsia; otherwise, amphetamine and methylphenidate exposure was not associated with the risk of preeclampsia, placental abruption, small for gestational age, or preterm birth. Late gestational exposure to psychostimulants was associated with an increased risk of preterm birth but not with the other adverse outcomes. In sensitivity analyses, such as one that examined exposure during weeks 8-18 of gestation, amphetamines were associated with an increased risk of preeclampsia, placental abruption, and preterm birth, and methylphenidate, with an increased risk of preeclampsia. For reasons explained in the text, it may be prudent to err on the side of caution, but in the worst case scenario, the number needed to harm is about 63 for amphetamines exposure and preeclampsia and larger (eg, > 500, indicating less risk) for other adverse outcomes. Atomoxetine was not associated with any adverse gestational outcome, but it is not clear whether this is a true finding or a result of underpowered analyses. In conclusion, women need to weigh the benefits of the ADHD medication that they are using against potential gestational risks when deciding whether or not to continue treatment during pregnancy.