Antenatal exposure to Wellbutrin (bupropion) does not appear to be associated with an increased risk of malformations in the exposed infant; however,  it is not known if exposure to Wellbutrin during pregnancy has any effect on the child’s neurobehavioral development. In a study from Figueroa and colleagues published in 2010, insurance claims data from 38,704 children and their families were analyzed, using information obtained from the beginning of pregnancy until age 5.  Outcomes were assessed in mothers taking selective serotonin reuptake inhibitors (SSRIs) or Wellbutrin before, during or after the pregnancy.  This study sought to determine the risk of ADHD in exposed infants.  Children up to the age of 5 were identified as having ADHD if they had an outpatient or inpatient claim with a primary or secondary diagnosis of ADHD or a prescription claim for stimulants.

As anticipated, a diagnosis of ADHD in the mother or father was associated with higher rates of ADHD diagnosis in the children.  A diagnosis of bipolar disorder (OR = 5.08), psychotic disorders (OR = 4.05), and depressive disorders (OR = 2.58) in the mother, but not in the father, increased the risk of ADHD in the child.

Higher rates of ADHD were observed in infants exposed to bupropion during pregnancy (OR = 3.63), especially during the second trimester (OR = 14.66); in contrast, there was no increase in ADHD risk in those exposed to SSRIs (OR = 0.91).

Although this study indicates a strong association between Wellbutrin exposure and increased risk of ADHD in the child, this association does not necessarily imply causation.  We cannot assume that mothers who choose to take Wellbutrin are identical to those who choose to take an SSRI.  Thus there may be confounding factors – ones not fully measured in this study — that contribute to increased risk of ADHD.

We do know that other environmental factors have been shown to increase the risk of ADHD in the child.  Exposure during pregnancy to alcohol, tobacco, cocaine and heroin (Knopik et al, 2006; Milberger et al, 1996; Linares et al, 2006; Ornoy et al, 2001), perinatal complications such as prematurity or low birth weight (Ben Amor et al, 2005; Lou et al, 1996), or maternal obesity (Rodriguez et al, 2008) have all been identified as ADHD risk factors. In addition, exposure to stress during pregnancy (Huizink et al, 2007; Van Der Bergh, 2004) or mental illness after birth (including postpartum depression) have also been associated with worse pregnancy outcomes and increased risk of ADHD in the child (Grizenko et al, 2008; Carter et al, 2001).  Given the limitations of the claims database, the researchers were not able to control for m any of these potential confounders.  Further studies are needed to better delineate the effects of Wellbutrin on the neurobehavioral development of the child.

Snezana Milanovic, MD

 

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