Medscape reports that two large studies of pregnant women diagnosed with attention-deficit hyperactivity disorder (ADHD) found that stimulant medications used to treat the condition are associated with an increased risk of perinatal and placental abnormalities.
In a study lead by Ulrika Norby, MSc Pharm, PhD, researchers analyzed singleton births recorded in the Swedish Medical Birth Register (MBR) between July 1, 2006 and December 31, 2014. The final sample consisted of 964,734 infants, of whom 1,591 were exposed to ADHD drugs during gestation and 9,475 were born to mothers who used ADHD medications before or after, but not during, pregnancy. Stimulants accounted for roughly 92% of in utero exposures.
The rate of NICU admission among infants exposed to ADHD medications during pregnancy was noted to be higher than that of infants whose mothers had never used ADHD medications. A risk increase was also noted among mothers who used the medications before or after pregnancy.
Additionally, ADHD medication use during pregnancy was associated with a higher frequency of:
In the second study lead by Jacqueline M. Cohen, PhD, researchers evaluated the effects of ADHD on the risk of preeclampsia, placental abruption, fetal growth restriction, and preterm birth among women enrolled in Medicaid who delivered a child between 2000 and 2010.
The final cohort consisted of 1,466,792 women, 4,846 of whom use d stimulants for ADHD during pregnancy and 453 who used atomoxetine. The remaining 1,461,493 were in the control group.
After adjusting for various risk factors, stimulant use was associated with a relative risk for preeclampsia of 1.29, 1.13 for placental abruption, 0.91 for infants born small, and 1.06 for preterm birth compared with no exposure.
According to Medscape, authors from both study agree that the increases are modest and any risk must be considered next to the severity of ADHD symptoms.
Norby, lead author of the first of the two studies, stated, “Poorly controlled ADHD symptoms might result in poorer adherence to antenatal care, an unhealthier lifestyle, and increased maternal stress that, in turn, can affect the fetus negatively.”
With that, Norby concluded that if the medication is essential in managing a woman’s ADHD symptoms, “we do not find that our results concerning neonatal complications justify abstaining from therapy.”
The lead author of the other study, Cohen, provided similar insight saying, “It is important to balance the benefits of treatment, which may improve functioning, including maintaining family relationships, adherence to prenatal care, and avoidance of substance abuse.”