Are stimulant medications for ADHD safe to use during pregnancy?

The prevalence of attention deficit hyperactivity disorder (ADHD) in adults has increased in recent years, with a current estimated prevalence of about 5% in the United States. As a result, the use of medications for ADHD during pregnancy is also increasing. Whether exposure to these medications during pregnancy affects the risk of neurodevelopmental disorders in children is uncertain. Stimulant medications are known to cross the placenta and can increase the concentrations of norepinephrine and dopamine, which may play an important role in fetal neurodevelopment.To further examine this issue, a new study has evaluated the association of childhood neurodevelopmental disorders with in utero exposure to stimulant medications for ADHD. The cohort study included healthcare utilization data from publicly insured (from 2000–2018) and commercially insured (from 2003–2020) pregnant individuals 12–55 years of age in the United States. Children were monitored from birth until outcome diagnosis, disenrollment, death or end of the study. The main outcomes were the occurrence of autism spectrum disorder, ADHD, and a composite of any neurodevelopmental disorder. Hazard ratios were estimated comparing amphetamine/dextroamphetamine and methylphenidate to no exposure.Results showed the following:The publicly insured cohort included 2,496,771 stimulant-unexposed, 4,693 amphetamine/dextroamphetamine-exposed, and 786 methylphenidate-exposed pregnancies (mean age 25.2 years). The commercially insured cohort included 1,773,501 stimulant-unexposed, 2,372 amphetamine/dextroamphetamine-exposed, and 337 methylphenidate-exposed pregnancies (mean age 31.6 years). In unadjusted analyses, amphetamine/dextroamphetamine and methylphenidate exposure were associated with a two- to three-fold increased risk of the specified neurodevelopmental outcomes. After adjustment for measured confounders, amphetamine/dextroamphetamine exposure was not associated with any neurodevelopmental 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). After adjustment for measured confounders, methylphenidate exposure was associated with an increased risk of ADHD (HR 1.43; 95%CI, 1.12–1.82]), but not other neurodevelopmental outcomes (autism spectrum disorder: HR 1.06; 95%CI, 0.62–1.81; any neurodevelopmental disorder: HR 1.15; 95%CI, 0.97–1.36). The association between methylphenidate and ADHD did not persist in sensitivity analyses with stricter control for confounding by maternal ADHD.The authors conclude that based on this cohort of more than four million insured pregnancies in the United States with up to 18 years of follow-up, amphetamine/dextroamphetamine and methylphenidate exposure during pregnancy are not likely to meaningfully increase the risk of childhood neurodevelopmental disorders. With the recent rise in use of stimulant medications for ADHD in adults and during pregnancy, the authors believe these results will be reassuring for patients who depend on these medications throughout pregnancy for control of debilitating ADHD symptoms that interfere with daily functioning.Reference1. Suarez EA, Bateman BT, Hernandez-Diaz S, et al. Prescription stimulant use during pregnancy and risk of neurodevelopmental disorders in children. JAMA Psychiatry 2024; Published online January 24, 2024. (accessed January 25, 2024).

Are stimulant medications for ADHD safe to use during pregnancy?

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