Should Women Stop ADHD Meds During Pregnancy?

Continuing dexamphetamine for attention deficit-hyperactivity disorder (ADHD) during pregnancy was not associated with a higher likelihood of adverse maternal and neonatal outcomes compared with stopping the medication during pregnancy. A population-based retrospective cohort study from Western Australia found, though, that women who had ceased taking the drug prior to becoming pregnant had the lowest odds of adverse outcomes.

Women who ceased use of the medication had greater odds of threatened abortion — vaginal bleeding prior to 20 weeks’ gestation — compared with continuers (OR 2.28, 95% CI 1.00-5.15, P=0.049), reported researchers led by Danielle Russell, a PhD student at the University of Western Australia in Crawley, in Archives of Women’s Mental Health.

However, unexposed women — i.e., those who took dexamphetamine before pregnancy but not during — had lower odds of multiple adverse outcomes versus those who continued taking the medication throughout their pregnancy:

• Preeclampsia (OR 0.58, 95% CI 0.35-0.97, P=0.037)
• Hypertension (OR 0.32, 95% CI 0.11-0.93, P=0.036)
• Postpartum hemorrhage (OR 0.57, 95% CI 0.41-0.80, P=0.001)
• Neonatal special care unit admittance (OR 0.16, 95% CI 0.12-0.20, P<0.001)
• Fetal distress (OR 0.73, 95% CI 0.54-0.99, P=0.042)

ADHD diagnoses are becoming more common among women, leading to more women of reproductive age taking ADHD medications. For that reason, Russell and co-authors sought to better understand the safety of dexamphetamine during pregnancy, she told MedPage Today.

“Those who had stopped taking the medication did have a greater risk of possibly losing their pregnancy, but we don’t know if that’s due to them stopping the medication and having a withdrawal, or if they were at risk of losing their pregnancy and therefore they stopped,” Russell said.

Nancy Byatt, DO, MBA, a perinatal psychiatrist and executive director of the Lifeline for Families Center at UMass Chan Medical School in Worcester, Massachusetts, who was not involved in the study, said whenever a pregnant patient is being exposed to a medication, it’s important to think about the risks from the medication, as well as the risk of untreated illness.

“ADHD itself also has risks,” she noted.

Byatt recalled a patient who once told her, “‘If I can’t have access to the medication, I’m going to need to terminate my pregnancy, because I cannot take care of the four children I have at home.’ That’s a really good reason to stay on an ADHD medication.”

There’s also evidence that if ADHD isn’t treated during pregnancy, risks of depression and anxiety may increase in the postpartum period, she added.

“So these are all the things [psychiatrists] are taking into account and this [study] gives us more information as we’re weighing these risks and benefits,” she said. But “we wouldn’t make a sweeping recommendation based on really any one study; we take into account all the data, and what’s most important is we take into account the … person we’re working with, with lived experiences of their own. There is never really a hard and fast rule.”

For this study, the researchers used the Midwives Notification System (MNS), the Monitoring of Drugs of Dependence System (MODDS), the Hospital Morbidity Data Collection, and the WA Registry of Births, Deaths and Marriages.

Eligible study participants were identified by linking data from the MNS, which contains information for both mother and child, to the MODDS, which includes information on the dispensing of all Schedule 8 medications.

The researchers included 844 women who had been given dexamphetamine during pregnancy and gave birth from 2003 to 2018: 547 women continued dexamphetamine (mean age 29.2) and 297 ceased dexamphetamine before the end of the second trimester (mean age 28.6).

They also included 844 women in the unexposed group (mean age 27.2), who were dispensed dexamphetamine prior to pregnancy but not during pregnancy.

Women in the unexposed group were more likely to have been hospitalized with mental health conditions within the 5 years prior to conception compared with women who continued treatment (OR 1.58, 95% CI 1.18-2.12, P=0.002).

Those who ceased medication use were not significantly different from the group who continued in terms of smoking status, diagnosis of diabetes, number of previous pregnancies, mental health hospitalizations, and socioeconomic status, Russell and team noted.

A major limitation to the study was the researchers’ inability to examine spontaneous abortions, as well as the study’s small sample size and limited demographic variation, which could limit its generalizability.

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