Maternal and neonatal outcomes after exposure to ADHD medication during pregnancy: A systematic review and meta-analysis.

ABSTRACT

PURPOSE: Attention-deficit/hyperactivity disorder (ADHD) medications are used by increasing numbers of reproductive-age women. The safety of these medications during pregnancy has not been well described. METHODS: A systematic review and meta-analysis was performed to evaluate the adverse maternal and neonatal outcomes associated with exposure to ADHD medication during pregnancy. The PubMed and Embase databases were searched to identify potential studies for inclusion. RESULTS: Eight cohort studies that estimated adverse maternal or neonatal outcomes associated with exposure to ADHD medication during pregnancy were included. Exposure to ADHD medication was associated with an increased risk of neonatal intensive care unit (NICU) admission compared with no exposure at any time (risk ratio (RR) 1.88; 95% confidence interval (CI), 1.7-2.08) and compared with women with exposure either before or after pregnancy (RR 1.38; 95% CI, 1.23-1.54; P < 0.001). Exposure to methylphenidate (MPH) was marginally associated with an increased risk for cardiac malformation (RR 1.27; 95% CI, 0.99-1.63; P = 0.065) compared with no exposure. However, exposure to ADHD medication was not associated with an increased risk for other adverse maternal or neonatal outcomes. This analysis was limited by the small number of studies included and the limited adjustments for the possible confounders in the studies. CONCLUSIONS: Exposure to ADHD medication during pregnancy does not appear to be associated with adverse maternal or neonatal outcomes. Given the few studies included, further larger, prospective studies that control for important confounders are needed to verify our findings.