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Stimulant Treatment for ADHD Safe to Continue During Pregnancy
Amphetamine/dextroamphetamine and methylphenidate exposure in utero are unlikely to increase the risk of childhood neurodevelopmental disorders, according to a recent cohort study published in JAMA Psychiatry.
“Given the recent rise in use of stimulant medications for ADHD in adults and during pregnancy, these results are reassuring for patients who depend on these medications throughout pregnancy for control of debilitating ADHD symptoms that interfere with daily functioning,” authors noted.
>>Quiz: By how much did ADHD diagnosis increase dementia risk?
The study, conducted using health care utilization data from publicly insured (Medicaid data from 2000 to 2018) and commercially insured (MarketScan Commercial Claims Database data from 2003 to 2020) pregnant individuals in the United States, included extensive monitoring of children from birth until outcome diagnosis or end of the study period. Children were monitored from birth until outcome diagnosis, disenrollment, death, or end of the study (December 2018 for Medicaid and December 2020 for MarketScan). The main outcomes assessed were autism spectrum disorder (ASD), ADHD, and a composite of any neurodevelopmental disorder. The main exposure was the dispensing of amphetamine/dextroamphetamine or methylphenidate in the second half of pregnancy.
The publicly insured group included 2,496,771 stimulant-unexposed, 4693 amphetamine/dextroamphetamine-exposed, and 786 methylphenidate-exposed pregnancies with a mean age of 25.2 years. The commercially insured cohort included 1,773,501 stimulant-unexposed, 2372 amphetamine/dextroamphetamine-exposed, and 337 methylphenidate-exposed pregnancies with a mean age of 31.6 years.
Adjusted analyses showed no significant association between amphetamine/dextroamphetamine exposure and any outcome (autism spectrum disorder: hazard ratio [HR], 0.80; 95% CI, 0.56-1.14]; ADHD: HR, 1.07; 95% CI, 0.89-1.28; any neurodevelopmental disorder: HR, 0.91; 95% CI, 0.81-1.28). Methylphenidate exposure, however, was associated with an increased risk of ADHD (HR, 1.43; 95% CI, 1.12-1.82]), but not with other outcomes after adjustment (autism spectrum disorder: HR, 1.06; 95% CI, 0.62-1.81; any neurodevelopmental disorder: HR, 1.15; 95% CI, 0.97-1.36). Sensitivity analyses with stricter control for confounding factors by maternal ADHD showed that the association between methylphenidate and ADHD did not persist.
Researchers acknowledged limitations in the study’s cohort design, such as potential inaccuracies in identifying medication consumption and outcome classification. They also noted that stimulants for ADHD may be used on an as-needed basis, so “evidence of a dispensing may not indicate consumption.”
