Because using ADHD medications in reproductive-aged women appears to be increasingly common, additional research on the reproductive safety of ADHD medications is required in order that we will inform women and their health care providers about any potential risks related to ADHD medication exposure while pregnant. While we now have a growing body of literature investigating the chance of major malformations in infants with prenatal exposure to commonly used stimulant medications, we now have less information on the long-term effects of prenatal exposure to ADHD medications.
A recent population-based cohort study leveraged data from the Danish national registers to research neurodevelopmental outcomes and growth in children exposed to ADHD medication. This evaluation included 1,068,073 liveborn singletons born between 1998 and 2015 who were followed until the diagnosis of any developmental disorder, death, emigration, or December 31, 2018.
The outcomes of 898 children born to moms who continued ADHD medication treatment while pregnant (with methylphenidate, amphetamine, dexamphetamine, lisdexamfetamine, modafinil, atomoxetine, or clonidine) were in comparison with the outcomes of 1,270 children born to moms with ADHD who had discontinued ADHD medications prior to pregnancy. As well as, they included one other reference group of ladies (n=1,065,905) with no exposure to ADHD medication either before or while pregnant.
As is the case in most naturalistic studies, women with ADHD (whether or not they selected to proceed or stop medication) differed from women with no ADHD. Specifically, in the discontinuation and exposed groups, a bigger proportion of moms were younger than 25 years of age at delivery (40.9% and 33.6%) versus 12.8% within the unexposed group. As well as, a bigger proportion of kids were born preterm (8.0% and 9.1%) within the discontinuation and exposed groups in comparison with the unexposed group (5.7%). Women within the discontinuation and exposed groups also had low birthweight (6.2% and 6.5%) in comparison with the unexposed group (3.6%). The discontinuation and exposed groups had lower proportions of moms with greater than a ninth grade education (41% and 39.8%, respectively) in comparison with the unexposed group (82.2%) and better proportions of smokers while pregnant (41.2% and 42.9%) in comparison with the unexposed group (15.4%).
Reassuring But Limited Information on the Risk of Neurodevelopmental Disorders
Outcomes in children exposed to ADHD medication were in comparison with outcomes in a control group of 1270 children whose moms discontinued ADHD medication prior to pregnancy. After adjusting for potential confounding variables, the researchers observed no increased risk of any developmental disorders within the exposed in comparison with unexposed offspring (adjusted hazards ratio 0.97, 95% CI 0.81 to 1.17). Taking a look at specific subcategories of developmental disorder, the researchers observed no differences in rates of ADHD, autism spectrum disorder, cerebral visual or auditory impairments, seizure disorders, or growth restriction when comparing children who were prenatally exposed to ADHD medication with children whose moms discontinued ADHD medication prior to pregnancy.
The variety of childbearing women receiving treatment with ADHD medications is on the rise. While we now have reassuring data on the chance of major malformations in women treated with stimulant medications, in addition to atomoxetine, our data regarding the long-term effects of prenatal exposure to ADHD medications is sparse. These findings will undoubtedly be reassuring to women with ADHD who’re considering using ADHD medications in pregnancy.
One among the shortcomings of this study, nonetheless, is that ADHD medications were regarded as a bunch together. The vast majority of women (n=703) used methylphenidate while pregnant; fewer women used amphetamines (n=20) or other medications, including atomoxetine (n=125), clonidine and modafinil (n=50). While these medications may share certain similarities, there are structural and chemical differences which will potentially affect outcomes. Thus, the information is more reassuring for methylphenidate but might not be generalizable to other ADHD medications. Future study will help to supply more information on the opposite ADHD medications.
Ruta Nonacs, MD PhD
References
Bang Madsen K, Robakis TK, Liu X, Momen N, Larsson H, Dreier JW, Kildegaard H, Groth JB, Newcorn JH, Hove Thomsen P, Munk-Olsen T, Bergink V. In utero exposure to ADHD medication and long-term offspring outcomes. Mol Psychiatry. 2023 Feb 9.