Analyzing data from the Swedish Medical Birth Register, the Prescribed Drug Register, and the Swedish Neonatal Quality Register, researchers compared infants exposed to ADHD medication during pregnancy with infants whose mothers never used these drugs and infants whose mothers used ADHD medication before or after (but not during) pregnancy. Out of 964,734 infants included in the analysis, 1,591 (0.2%) were exposed to ADHD medication during pregnancy.
Exposure to ADHD medications during pregnancy increased the risk for NICU admission, as compared to no maternal use (adjusted odds ratio [aOR], 1.5; 95% confidence interval [CI], 1.3-1.7) or to use before or after pregnancy (aOR, 1.2; 95% CI, 1.1-1.4). Looking at specific outcomes, infants exposed during pregnancy were more likely to have central nervous system-related disorders (aOR, 1.9; 95% CI, 1.1-3.1) and were more often moderately preterm (aOR, 1.3; 95% CI, 1.1-1.6) than non-exposed infants.
There was no increased risk for congenital malformations or perinatal death.
These findings are consistent with previous studies which have demonstrated an increased risk of perinatal complications in infants exposed to stimulants during pregnancy. However, what makes this study more useful and clinically relevant is that it focuses on exposure to stimulants prescribed in standard doses, as opposed to previous studies which studied outcomes primarily in women who were abusing or misusing stimulants in combination with other substances.
While this study demonstrated that treatment with ADHD medication during pregnancy was associated with a small but higher risk for neonatal morbidity, especially central nervous system-related disorders, the authors urge caution in the interpretation of these results, stating, “Because of large differences in background characteristics between treated women and controls, it is uncertain to what extent this can be explained by the ADHD medication per se.” Overall, this study provides reassuring data, indicating no increase in congenital malformations and relatively low risk of adverse outcomes in women using ADHD medications during pregnancy.
Ruta Nonacs, MD PhD
Nörby U, Winbladh B, Källén K. Perinatal Outcomes After Treatment With ADHD Medication During Pregnancy. Pediatrics. 2017 Dec;140(6).
It is incredibly important to take the results of this study with a heaping tablespoon of salt when discussing ADHD medication use in pregnancy with patients. There are several important aspects of the study which are left out of the above summary:
1. This study does NOT apply to all ADHD medication. 90% of the mothers in the study population who used ADHD medication used methylphenidate (Ritalin) whereas the remainder used Atomoxetine (Strattera). Therefore, the results of this study *cannot* be generalized to all ADHD medications – Adderall, Vyvanse, etc were NOT included.
2. The study populations for mothers who did and did not use ADHD medications in pregnancy were significantly different in a wide variety of factors: “Women treated with ADHD drugs were younger, more often nulliparous, smokers, obese, more frequently lived without the father of the child, and they also used other medications to a larger degree.” These differences can significantly bias the study results, even when included in logistic regression.
3. Most of these confidence intervals start at 1.1 (some at 1.0) so there are major concerns with regards to the significance of the associations.
4. Finally, and perhaps most importantly, this study DID NOT CONTROL FOR ALCOHOL AND/OR ILLICIT DRUG USE. Both of these are associated with a) ADHD diagnosis and b) negative birth outcomes, so failure to include alcohol and drug use in the study casts significant doubt on the veracity of the overall findings.
In conclusion: If you are a practitioner who is scare-mongering patients and/or denying them ADHD medication based solely on the findings of this study, you are basing these decisions on poor science with little evidence, and you need to re-assess your clinical care.