Risk of Major Congenital Malformations Associated With the Use of Methylphenidate or Amphetamines in Pregnancy

Andrade, Chittaranjan

doi:10.4088/jcp.18f12108

Cited by 6 publications

(2 citation statements)

References 22 publications

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“…An increasing number of studies have investigated the effect of ADHD medication on foetal malformations and pregnancy outcomes, but the results of these studies have been inconsistent. The most recent systematic review on the topic identified six studies but did not provide an overall estimate of the effect of ADHD medication on maternal or neonatal outcomes. Since that systematic review was published, several additional studies have been published, allowing a more detailed analysis.…”

Section: Introductionmentioning

confidence: 99%

Maternal and neonatal outcomes after exposure to ADHD medication during pregnancy: A systematic review and meta‐analysis

Jiang

Zhang

Jiang

et al. 2018

Pharmacoepidemiology and Drug

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Purpose Attention‐deficit/hyperactivity disorder (ADHD) medications are used by increasing numbers of reproductive‐age women. The safety of these medications during pregnancy has not been well described. Methods A systematic review and meta‐analysis was performed to evaluate the adverse maternal and neonatal outcomes associated with exposure to ADHD medication during pregnancy. The PubMed and Embase databases were searched to identify potential studies for inclusion. Results Eight cohort studies that estimated adverse maternal or neonatal outcomes associated with exposure to ADHD medication during pregnancy were included. Exposure to ADHD medication was associated with an increased risk of neonatal intensive care unit (NICU) admission compared with no exposure at any time (risk ratio (RR) 1.88; 95% confidence interval (CI), 1.7‐2.08) and compared with women with exposure either before or after pregnancy (RR 1.38; 95% CI, 1.23‐1.54; P < 0.001). Exposure to methylphenidate (MPH) was marginally associated with an increased risk for cardiac malformation (RR 1.27; 95% CI, 0.99‐1.63; P = 0.065) compared with no exposure. However, exposure to ADHD medication was not associated with an increased risk for other adverse maternal or neonatal outcomes. This analysis was limited by the small number of studies included and the limited adjustments for the possible confounders in the studies. Conclusions Exposure to ADHD medication during pregnancy does not appear to be associated with adverse maternal or neonatal outcomes. Given the few studies included, further larger, prospective studies that control for important confounders are needed to verify our findings.

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Section: Introductionmentioning

confidence: 99%

Maternal and neonatal outcomes after exposure to ADHD medication during pregnancy: A systematic review and meta‐analysis

Jiang

Zhang

Jiang

et al. 2018

Pharmacoepidemiology and Drug

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“…1 North American data suggest similar trends; one study reported that the use of ADHD medications in pregnancy rose from 0.2% during 1997-1998 to 1.3% during 2013. 2 An earlier article in this column 3 examined the risk of major congenital malformations following first trimester gestational exposure to psychostimulant medications; in summary, there did not seem to be sufficient evidence, at present, to suggest that methylphenidate and amphetamines are teratogenic. The present article examines whether ADHD medications are associated with other adverse gestational outcomes; data from 1 large 4 and 4 smaller 1,5-7 studies are specifically reviewed.…”

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confidence: 99%

Adverse Gestational Outcomes Associated With Attention-Deficit/Hyperactivity Disorder Medication Exposure During Pregnancy

Andrade

2018

J. Clin. Psychiatry

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The use of attention-deficit/hyperactivity disorder (ADHD) medications during pregnancy has increased in recent years. An earlier article in this column examined whether psychostimulant medications, used to treated ADHD and related disorders, increase the risk of major congenital malformations in pregnancies with first trimester exposure to these drugs. This article examines whether amphetamines, methylphenidate, and atomoxetine exposure during early and late pregnancy are associated with other adverse gestational outcomes. One large and 4 small studies provided data relevant to the inquiry. In unadjusted analyses, amphetamines and methylphenidate were associated with an increased risk of most of the adverse outcomes under study. However, in analyses adjusted for potential confounds, amphetamine exposure during early pregnancy was associated only with an increased risk of preeclampsia; otherwise, amphetamine and methylphenidate exposure was not associated with the risk of preeclampsia, placental abruption, small for gestational age, or preterm birth. Late gestational exposure to psychostimulants was associated with an increased risk of preterm birth but not with the other adverse outcomes. In sensitivity analyses, such as one that examined exposure during weeks 8-18 of gestation, amphetamines were associated with an increased risk of preeclampsia, placental abruption, and preterm birth, and methylphenidate, with an increased risk of preeclampsia. For reasons explained in the text, it may be prudent to err on the side of caution, but in the worst case scenario, the number needed to harm is about 63 for amphetamines exposure and preeclampsia and larger (eg, > 500, indicating less risk) for other adverse outcomes. Atomoxetine was not associated with any adverse gestational outcome, but it is not clear whether this is a true finding or a result of underpowered analyses. In conclusion, women need to weigh the benefits of the ADHD medication that they are using against potential gestational risks when deciding whether or not to continue treatment during pregnancy.

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Management of Hypersomnia in Pregnancy

Freedom¹,

Rasameesoraj

2020

Current Clinical Neurology

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Risk of Major Congenital Malformations Associated With the Use of Methylphenidate or Amphetamines in Pregnancy

Cited by 6 publications

References 22 publications

Maternal and neonatal outcomes after exposure to ADHD medication during pregnancy: A systematic review and meta‐analysis

Maternal and neonatal outcomes after exposure to ADHD medication during pregnancy: A systematic review and meta‐analysis

Adverse Gestational Outcomes Associated With Attention-Deficit/Hyperactivity Disorder Medication Exposure During Pregnancy

Management of Hypersomnia in Pregnancy

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