Is it safe to use ADHD medications during pregnancy?

“Should I discontinue stimulants when I am pregnant?” “Is it harmful to my developing baby if I take ADHD medications during my pregnancy?” “What are the risks both to me and my baby if my ADHD goes untreated?” “What is the best way to manage my ADHD during pregnancy?” – For women with ADHD who become pregnant, especially those with moderate or severe ADHD symptoms, the next few months are filled with questions. One important decision for the pregnant women and their clinician is whether to remain on or cease their ADHD medication treatment before or during pregnancy, or while breastfeeding. Unfortunately, there is no clear ADHD treatment guidelines for pregnant women, which further complicates these decisions. Therefore, there is a need for high-quality evidence to support guidelines for the use of ADHD medication during pregnancy.

Given that, it is unethical to include pregnant and breastfeeding women in clinical trials, evidence-based guidelines need to rely on findings from naturalistic studies. So, what does the available findings from naturalistic studies tell us?  

In our newly published paper in CNS Drugs (https://doi.org/10.1007/s40263-020-00728-2), we conducted a systematic review to synthesize all available evidence regarding the safety of ADHD medication use while pregnant, with a focus on how these studies have handled the influence of confounding, which may bias the estimates from observational studies.

We identified eight cohort studies that estimated adverse pregnancy-related and offspring outcomes associated with exposure to ADHD medication during pregnancy. These studies varied a lot in data sources, type of medications examined, definitions of studied pregnancy-related and offspring outcomes etc. Overall, there was no convincing evidence for an association between maternal ADHD medication use during pregnancy and adverse pregnancy and offspring outcomes. Some studies suggested a small increased risk of low Apgar scores, preeclampsia, preterm birth, miscarriage, cardiac malformations, admission to a NICU, and central nervous system (CNS)-related disorder, but other available studies failed to detect similar associations. Because of the limited number of studies and inadequate confounding adjustment, it is currently unclear whether these small associations are due to a causal effect of prenatal exposure to ADHD medication or confounding.

In conclusion, the current evidence does not suggest that the use of ADHD medication during pregnancy results in significant adverse consequences for mother or offspring. However, the data are too limited to make an unequivocal recommendation. Therefore, physicians should consider whether the advantages of using ADHD medication outweigh the potential risks for the developing fetus according to each woman’s specific circumstances.

More information here:

Li, L., Sujan, A.C., Butwicka, A. et al. Associations of Prescribed ADHD Medication in Pregnancy with Pregnancy-Related and Offspring Outcomes: A Systematic Review. CNS Drugs (2020). https://doi.org/10.1007/s40263-020-00728-2

Authors:

Lin Li, MSc, PhD student in the School of Medical Science, Örebro University, Sweden.

Henrik Larsson, PhD, professor in the School of Medical Science, Örebro University and Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Sweden.

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