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ADHD prescriptions among reproductive-aged women more than tripled in 12 years
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The increase was attributed to stimulant ADHD medications. Prescriptions for the nonstimulant medication atomoxetine have remained consistent since 2003.
“The substantial increase in the percentage of reproductive-aged women filling ADHD medication prescriptions from 2003 to 2015, across age groups and U.S. geographic regions, is of public health concern given the high percentage of unintended pregnancies and uncertainty concerning the safety of ADHD medication exposure before and during pregnancy,” the researchers wrote. “Although evidence is limited and findings are mixed, ADHD medication use during pregnancy might be linked to increased risk for poor pregnancy outcomes, including spontaneous abortion. The safety of ADHD medications with regard to risk for birth defects is largely unknown, with only one sufficiently powered published study.”
Kayla N. Anderson, PhD, of the Epidemic Intelligence Service and the National Center on Birth Defects and Developmental Disabilities at the CDC, and colleagues used the Truven Health MarketScan Commercial Database to identify outpatient pharmacy prescription drug claims for ADHD medications among reproductive-aged women (range, 15-44 years) between 2003 and 2015. The analysis was conducted among women with private health insurance who had been enrolled in the plan for 11 months or less; all insurance plans included prescription drug coverage.
The researchers evaluated time trends by calculating the change in the percentage of reproductive-aged women treated with ADHD medications from 2003 to 2015. The disbursement of specific medications and the average number of prescriptions filled per year were analyzed among women who filled at least one prescription for ADHD medication.
Prescriptions increase across all age groups, geographic regions
The sample included approximately 2.3 million to 6.8 million women of reproductive age who were privately insured for each year between 2003 and 2015 (median, 4.6 million). The percentage of these women with private, employer-sponsored health insurance who filled a prescription for any ADHD medication increased 344% from 2003 (0.9%) to 2015 (4%). The researchers also observed a 388% increase in the prescribing of stimulant medications between 2003 and 2015.
The percentage of women who filled a prescription for any ADHD medication increased over time across all age groups and geographic regions. Between 2003 and 2015, the greatest increase in ADHD prescriptions was 700% among women aged 25 to 29 years. The largest increase by region during the same time was 380% in the South.
Among women who filled any prescription for ADHD medication, the average number of prescriptions filled each year increased from an average of 5.5 prescriptions in 2003 to 7.2 in 2015.
The nearly 350% increase in the number of prescriptions is “very significant,” Kayla N. Anderson, PhD, of the Epidemic Intelligence Service and the National Center on Birth Defects and Developmental Disabilities at the CDC, told Healio Psychiatry.
“We didn’t examine the reasons for the increase, but we do have some possible explanations from previous research,” Anderson said. “We’ve seen a substantial increase in the number of kids who are diagnosed with, and treated for, ADHD in the last few decades; it may be that more people are experiencing ADHD symptoms into adulthood and continuing to take medication. The second possibility is increasing awareness in the medical and scientific community that ADHD is not just a childhood condition; it affects people of all ages. As awareness increases, we might also see that ADHD symptoms are being noticed more, and diagnosed more frequently, among adults.”
Anderson also commented on the finding that stimulant medications were the most frequently prescribed agents for ADHD among reproductive-aged women.
“This should enable us to focus our efforts on that class of medications when we’re looking at reproductive safety,” she said. “It will also help maximize our research: If we’re able to look at specific medications, let’s examine the ones taken by the most women.”
Weigh risks, benefits of ADHD medications during pregnancy
In addition to examining the reasons for the increase in ADHD prescriptions, Anderson hopes future research will try to determine the link between ADHD medications and specific birth defects. It has been difficult to analyze the link between specific medications and specific birth defects, she said; the research that does exist more commonly shows that medication use in general could influence the likelihood of birth defects.
“At this time, there is not enough information available to be able to look at ADHD medications and specific birth defects. It’s too early to draw firm conclusions,” Anderson said. “However, we also understand that health care providers want to discuss pregnancy considerations with women taking ADHD medications.”
Anderson advises health care providers to weigh the risks and benefits of ADHD medications with women who are thinking about getting pregnant or who are pregnant. Deciding whether to continue taking ADHD medication during pregnancy is one concern, which is associated with additional issues like the risks of leaving ADHD untreated if the choice is made not to continue medication. There may also be behavioral interventions that can be used in addition to, or instead of, medication to treat ADHD during pregnancy.
“Weighing the risks and benefits of each scenario, based on the woman’s health and symptom severity, is very important,” Anderson said. “The key takeaway from this study is that ADHD medication use is becoming much more common among reproductive-age women in the United States. We hope this finding helps to drive research forward in order to facilitate informed-decision making among women and their health care providers.” – by Julia Ernst, MS
Reference:
Anderson KN, et al. Morb Mortal Wkly Rep. 2018: doi: 10.15585/mmwr.mm6702a3.
Disclosures: The researchers report no relevant financial disclosures.