Prevalence Trends and Patterns of Perinatal ADHD Stimulant Medication Use in British Columbia, Canada

Given the increase in attention-deficit/hyperactivity disorder (ADHD) diagnoses and stimulant medication use among female adults, this study describes the prevalence trends of perinatal ADHD stimulant medication use in British Columbia, Canada, along with characteristics and patterns of use.

Using linked population-based administrative data, we included all pregnant people with deliveries between January 2000 and December 2021. ADHD stimulant medication use was defined as filled prescriptions for dextro-/amphetamine, methylphenidate, or lisdexamfetamine. Prevalence trends were examined by medication type and age group. Characteristics were compared between those with and without prenatal stimulant medication dispensations. Patterns of use and discontinuation were assessed from 1 year preconception to 1 year postpartum.

Our cohort included 899,679 pregnancies. Prenatal ADHD stimulant medication use increased by 3.9 users per 1000 pregnancies (from 0.4 to 4.3/1000), primarily driven by dextro-/amphetamine. Medication use increased among all age groups, but was highest among pregnant people under 20 years old. Pregnant people taking stimulant medications were more likely to be nulliparous and lower in income, have hypertension and higher BMI, smoke during pregnancy, use other psychotropic medications, and deliver by cesarean section. Among those who used stimulant medications within 1 year preconception, 77% discontinued treatment before or during pregnancy. While use increased again within 12 months postpartum, it remained 45% lower than preconception levels.

The 11-fold increase in ADHD stimulant medication use during pregnancy and the high rate of discontinuation highlight the need for more research on the risks and benefits of medication for parent and child health.