Trajectories of ADHD medication use before, during, and after pregnancy: A population‐based study from Norway and Sweden

Abstract

PurposeTo describe ADHD medication use trajectories around pregnancy in Norway and Sweden.MethodsWe identified pregnancies resulting in births using linked data from birth and prescribed drug registers of Norway (2006–2019, N = 813 107) and Sweden (2007–2018, N = 1 269 146). We restricted to women who filled prescriptions for ADHD medication during pregnancy or in the year before or after. We described exposure as use versus no use, and total amount of drug dispensed in defined daily doses (DDDs). Group‐based trajectory modeling was used to identify distinct medication use trajectories.ResultsIn total, 13 286 women (0.64%) filled a prescription for ADHD medication. We identified four trajectory groups: continuers (5.7%), interrupters (23.8%), discontinuers (49.5%), and late initiators (21.0%). Discontinuers were younger, continuers were older on average. More women continued medication in recent years (2014–2019). Most discontinuers (60.7%) were nulliparous; more initiators and continuers had one or multiple previous births, respectively. Continuers were least likely to live with a partner (65.8%). Discontinuers were least likely (24.7%) and continuers most likely (37.6%) to smoke at the beginning of pregnancy. More continuers used amphetamine derivatives and were most likely to use other psychotropics. On modeling continuers, we identified three dose‐trajectory groups which suggested that most women reduced medication dose during pregnancy.ConclusionsMost pregnant women discontinued or interrupted their ADHD medication during pregnancy, but more continued in recent years. Continuers were more likely to have had previous births, less likely to have lived with a partner, and may have had additional comorbidities warranting the use of other psychotropics.

Attention-Deficit Hyperactivity Disorder (ADHD) Medication Use Trajectories Among Women in the Perinatal Period

“…We identified four similar trajectory patterns as a recent study of ADHD medication trajectories using Norwegian and Swedish register data [ 17 ]; however, the proportion of pregnancies classified in each of the trajectory patterns varied, with a notably higher proportion of continuers in Denmark. This may be partly driven by the specification of the models, which resulted in a more highly selected group defined as continuers in Norway and Sweden (5.7%), with a higher proportion of women using ADHD medication in each period (around 80–90%).…”

“…It is essential to address this gap, as medication treatment decisions during these periods can have significant implications for both maternal and fetal/neonatal health. A recent study from Sweden and Norway found that ADHD medication use among women around pregnancy and postpartum follows multiple distinct patterns, with the majority discontinuing or pausing ADHD medication use around pregnancy, and continuation being rare [ 17 ]. These results need to be replicated to provide external validation.…”