Psychostimulants in Pregnancy Associated With Increased Risk of Preeclampsia, Preterm Birth

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The participants were advised to continue their ADHD medication.
The participants were advised to continue their ADHD medication.

HealthDay News — Psychostimulant use during pregnancy is associated with a small increased relative risk of preeclampsia and preterm birth, according to a study published online in Obstetrics & Gynecology.

Jacqueline M. Cohen, PhD, from Brigham and Women's Hospital in Boston, and colleagues examined data from a cohort of pregnant women and their liveborn neonates enrolled in Medicaid (from 2000 - 2010) to assess whether psychostimulants used to treat attention-deficit/hyperactivity disorder (ADHD) are associated with risk of adverse placental-associated pregnancy outcomes. They compared women who received amphetamine-dextroamphetamine (n=3331) or methylphenidate monotherapy (n=1515) in the first half of pregnancy to those who received atomoxetine, a nonstimulant ADHD medication, as a negative control exposure (n=453) and 1,461,493 unexposed pregnancies.

The researchers found that the adjusted risk ratio for stimulant use was 1.29 for preeclampsia (95% CI, 1.11-1.49), 1.13 for placental abruption (95% CI, 0.88 to 1.44), 0.91 for small for gestational age (95% CI, 0.77-1.07), and 1.06 for preterm birth (95% CI, 0.97-1.16). The adjusted risk ratio for continuation of stimulant use in the latter half of pregnancy (n=1319) was 1.26 for preeclampsia (95% CI, 0.94-1.67), 1.08 for placental abruption (95% CI, 0.67-1.74), 1.37 for small for gestational age (95% CI, 0.97-1.93), and 1.3 for preterm birth (95% CI, 1.1-1.55) compared with discontinuation (n=3527).

"The absolute increases in risks are small and, thus, women with significant ADHD should not be counseled to suspend their ADHD treatment based on these findings," conclude the authors.

Several authors disclosed financial ties to the pharmaceutical industry.

Reference

Cohen JM, Hernández-Díaz S, Bateman BT, et al. Placental complications associated with psychostimulant use in pregnancy [published online November 3, 2017]. Obstet Gynecol. doi:10.1097/AOG.0000000000002362



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