In utero exposure to ADHD medication does not alter neurodevelopment
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Children born to mothers taking ADHD medication did not have altered neurodevelopment or growth compared with those born to mothers not taking ADHD medication, according to findings published in Molecular Psychiatry.
“ADHD medication now ranks as one of the most prescribed medications during pregnancy,” Veerle Bergink, MD, PhD, director of the Women’s Mental Health Program and a professor of psychiatry at the Icahn School of Medicine at Mount Sinai in New York, told Healio. “We know from animal studies that ADHD medication (stimulants; methylphenidate and amphetamines) can pass the placenta and thus, there has been concerns that in utero exposure could harm the child’s neural development and growth. Worryingly, there are very few human studies on potential adverse effects of exposure to these medications during pregnancy for the offspring and none on the long-term effects on offspring neurodevelopmental outcomes.”
Bergink and colleagues identified 1,068,073 singleton live births among 628,478 mothers recorded in the Danish Medical Birth Registry from 1998 to 2015. Prenatal exposure to ADHD medication was evaluated using data from the Danish National Prescription Registry. The researchers defined ADHD medication use during pregnancy as having one or more prescriptions filled from 30 days before pregnancy until delivery.
Three primary outcomes were assessed individually and as a composite: neurodevelopmental psychiatric disorder, other neurodevelopmental impairment and growth impairment. The researchers followed children until one of these were diagnosed, the child died or emigrated, or the end of the study period (Dec. 31, 2018) was reached.
The researchers identified 1,837 (0.2%) children whose mothers used ADHD medication before pregnancy. Of these, 1,270 discontinued use and 567 continued use. Among the rest of the cohort, 331 mothers began using ADHD medication within 1 month of pregnancy. In total, 898 children were exposed to ADHD medication in utero.
Adjusted analyses revealed no differences between exposed and unexposed children in the risks for neurodevelopmental or growth impairment. Further analyses of first trimester exposure only and number of days of exposure did not reveal any significant differences.
Additionally, there were no statistically significant differences in neurodevelopmental psychiatric disorders, cerebral visual impairment, hearing impairment or febrile seizures. However, the risk for epilepsy was lower among children exposed vs. those unexposed to ADHD medication (adjusted HR = 0.58; 95% CI, 0.34-0.98).
In comparisons with unexposed children and unexposed siblings, children exposed to ADHD medication did not have increased risks for any outcomes, according to the researchers.
“Treating physicians should try to limit use of medication during pregnancy and — together with patients before conception — discuss if tapering is an option,” Bergink said. “If mothers have severe ADHD and need this medication to function and wish to continue, then they should search for the lowest dose.”
She added that the findings on long-term outcomes are “reassuring” but require further confirmation, given that available studies have had inconsistent findings. Other research should focus on the effects of medication tapering, she said.