How Has ADHD Medication Use During Pregnancy Changed in Recent Years?

What you need to know

• ADHD medication use during pregnancy increased in Norway and Sweden from 2010 to 2019, mainly driven by methylphenidate use
• Most pregnant individuals who used ADHD medication discontinued use during pregnancy
• Those who used ADHD medication during pregnancy were more likely to be younger, smoke, and use other psychotropic medications

ADHD medication use is increasing, including during pregnancy

Attention-deficit/hyperactivity disorder (ADHD) is a condition characterized by inattention, hyperactivity, and impulsivity that begins in childhood and often persists into adulthood. While ADHD was once thought to mainly affect children, there is growing awareness that many adults continue to experience symptoms and may benefit from treatment.

As recognition of adult ADHD has increased, so has the use of ADHD medications among adults, including women of reproductive age. This study looked at how ADHD medication use during pregnancy has changed in recent years in Norway and Sweden. The researchers analyzed data on all births from 2010 to 2019 in these two countries, linking information from birth registries to prescription databases.

Overall trends show increasing use, with differences between countries

The study found that ADHD medication use during pregnancy increased in both Norway and Sweden between 2010 and 2019:

• In Norway, use increased from 2.5 to 5.5 per 1,000 pregnancies
• In Sweden, use increased from 1.6 to 7.9 per 1,000 pregnancies

This means that by 2019, about 1 in 180 pregnancies in Norway and 1 in 125 pregnancies in Sweden involved ADHD medication use at some point before or during the pregnancy.

Interestingly, ADHD medication use was initially higher in Norway at the start of the study period but increased more steeply in Sweden. By 2019, use during pregnancy was more common in Sweden than Norway.

Methylphenidate drives the increase, with a new medication emerging

The increase in ADHD medication use was primarily driven by rising use of methylphenidate, which is sold under brand names like Ritalin and Concerta. Methylphenidate was the most commonly used ADHD medication in both countries throughout the study period.

However, in Sweden, there was also a notable increase in use of lisdexamfetamine (sold as Vyvanse) starting in 2015. By 2019, lisdexamfetamine accounted for almost half of ADHD medication use during pregnancy in Sweden, while it made up only about 10% of use in Norway.

This difference may be due to lisdexamfetamine being approved for use in adults earlier in Sweden (2015) compared to Norway (2018). Lisdexamfetamine is a prodrug, meaning it is inactive until metabolized in the body. This property may make it less likely to be misused compared to other stimulant ADHD medications, potentially contributing to its rapid uptake in Sweden.

Use increases across age groups but remains highest in young pregnant individuals

The study found that ADHD medication use increased across all age groups of pregnant individuals in both countries. However, use remained highest among the youngest pregnant individuals (those under age 20).

In Norway, the increase was only seen in pregnant individuals over age 20, while use among the youngest remained relatively stable. In Sweden, use increased across all age groups, including a substantial rise among the youngest pregnant individuals that peaked in 2016 before declining somewhat.

Most users discontinue medication during pregnancy

While ADHD medication use increased overall, the study found that most pregnant individuals who used these medications stopped taking them during pregnancy:

• In Norway, 85% discontinued use
• In Sweden, 78% discontinued use

Only about 1% of users initiated ADHD medication treatment after the first trimester of pregnancy. Among those who discontinued, about one-third resumed use within 6 months after giving birth.

These high discontinuation rates suggest that many individuals and their healthcare providers decide to stop ADHD medication use during pregnancy, likely due to concerns about potential risks to the developing fetus. However, suddenly stopping medication can also have negative impacts, so decisions about continuing or discontinuing treatment during pregnancy should be made carefully on an individual basis.

ADHD medication users have higher rates of other risk factors

The study found that pregnant individuals who used ADHD medication were more likely to have other characteristics that could increase risks during pregnancy compared to those who did not use ADHD medications:

• They were more often younger and having their first child
• They were less likely to be married or living with a partner
• They were more likely to smoke during pregnancy
• They were much more likely to use other types of psychotropic medications

Specifically, 42% of ADHD medication users in Norway and 65% in Sweden also used at least one other class of psychotropic medication during pregnancy. The most common co-medications were anti-anxiety medications, sleep aids, antidepressants, and opioid pain relievers.

These findings are important because they show that pregnant individuals who use ADHD medication may have multiple risk factors that could impact pregnancy outcomes. This makes it challenging for researchers to determine whether any increased risks are due to the ADHD medications themselves or other factors.

Implications for patients and healthcare providers

The increasing use of ADHD medications during pregnancy highlights the need for more research on their safety. Current evidence is limited, especially for newer medications like lisdexamfetamine. Some studies have found a modest increase in risk of heart defects with methylphenidate use during pregnancy, as well as possible links to preeclampsia and preterm birth. However, it’s unclear if these risks are due to the medication itself or other factors.

For patients with ADHD who are pregnant or planning pregnancy, it’s important to discuss the potential risks and benefits of continuing or stopping medication with a healthcare provider. Suddenly stopping ADHD medication can lead to worsening symptoms that may impact daily functioning and mental health. However, continuing medication use also carries potential risks that need to be carefully weighed.

Healthcare providers should be aware that pregnant patients using ADHD medication may have multiple risk factors that require extra monitoring and support during pregnancy. This could include referrals for smoking cessation, mental health support, or high-risk pregnancy care as needed.

Limitations and future research needs

This study only looked at pregnancies resulting in birth, not those ending in miscarriage or abortion. Some research suggests that women with ADHD may be at higher risk of pregnancy loss, though it’s unclear if this is related to the condition itself or medication use. Therefore, this study may underestimate total ADHD medication use in pregnancy.

Additionally, the study relied on records of prescriptions filled, not actual medication taken. Many individuals may have filled prescriptions shortly before or early in pregnancy but not actually used the medication while pregnant. This means the study likely overestimates actual use during pregnancy to some degree.

Future research is needed to better understand the safety of different ADHD medications during pregnancy, particularly newer options like lisdexamfetamine. Studies should also examine the impacts of continuing versus discontinuing medication on maternal mental health and functioning during pregnancy and postpartum.

Conclusions

• ADHD medication use during pregnancy increased in Norway and Sweden from 2010 to 2019, but most users discontinued use during pregnancy
• Methylphenidate was the most commonly used medication, with lisdexamfetamine use rising rapidly in Sweden in recent years
• Pregnant individuals who use ADHD medication often have multiple risk factors that may impact pregnancy, including younger age, smoking, and use of other psychotropic medications
• More research is needed on the safety of ADHD medications during pregnancy and the impacts of continuing versus discontinuing treatment