Attention-Deficit/Hyperactivity Disorder Medication Use in Pregnancy and Risk of Preterm Birth: A Population-Based
Chaitra Srinivas1,2,3, Øystein Karlstad1, Hein Stigum3
1Department of Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway.
Paediatric and Perinatal Epidemiology
|May 14, 2025
Summary
Attention-deficit/hyperactivity disorder (ADHD) medication use during pregnancy may slightly increase preterm birth risk, particularly with longer exposure durations and specific medications like atomoxetine and methylphenidate.
Area of Science:
- Reproductive Health
- Neurodevelopmental Disorders
- Pharmacovigilance
Background:
- Increasing use of attention-deficit/hyperactivity disorder (ADHD) medications during pregnancy.
- Limited evidence on fetal health safety and time-related biases in observational studies.
Purpose of the Study:
- To investigate the association between ADHD medication use in early and late pregnancy and preterm birth risk.
- To analyze the impact of medication type and duration on pregnancy outcomes.
Main Methods:
- Population-based cohort study using national registers from Norway and Sweden (2007-2020).
- Included singleton births with ADHD medication use in the year prior to conception.
- Assessed ADHD medications (amphetamines, methylphenidate, atomoxetine, etc.) in early (≤21 weeks) and late pregnancy (>22 weeks).
Main Results:
- Early pregnancy ADHD medication use (≥2 prescriptions) associated with higher preterm birth risk (aRR 1.29).
- Late pregnancy use linked to increased preterm birth risk (aHR 1.15).
- Each 30-day increase in late pregnancy exposure correlated with a 7% rise in preterm birth risk.
Conclusions:
- ADHD medication use may modestly elevate preterm birth risk.
- Atomoxetine in early pregnancy and methylphenidate in late pregnancy showed increased risk.
- Longer duration of ADHD medication use during pregnancy is associated with higher preterm birth risk.
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