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).