Psychostimulant Continuation and Postpartum Mental Health in Pregnant People With Attention-Deficit/Hyperactivity...

To evaluate the association between psychostimulant continuation, compared with discontinuation, and postpartum mental health outcomes in pregnant people with attention-deficit/hyperactivity disorder (ADHD) who had consistent psychostimulant prescriptions before pregnancy.

This was a retrospective cohort study that used the Merative MarketScan Commercial Claims Database (2011-2021). Included individuals were aged 13-50 years with singleton pregnancies, had delivered at or after 20 weeks of gestation, and had an ADHD diagnosis and psychostimulant adherence. Psychostimulant use during pregnancy was classified as no refills, the proportion of days covered below 80%, or the proportion of days covered at or above 80%. The primary outcomes were mental health events that occurred within 1 year postpartum, such as emergency department or inpatient mental health-related admissions, and new diagnoses of mood or anxiety disorders. Adjusted event rate ratios were estimated using Poisson regression, controlling for maternal age, gestational age at delivery, maternal comorbidities, and preexisting mental health diagnoses.

Among 3,676 eligible patients, 1,521 (41.4%) had no psychostimulant prescriptions during pregnancy (discontinued), 1,899 (51.7%) had a proportion of days covered below 80%, and 256 (7.0%) maintained a proportion of days covered at or above 80%. Overall, 3.3% (95% CI, 2.7-4.0%) experienced postpartum mental health-related admissions and 16.2% (95% CI, 14.6-18.0%) received new postpartum mood or anxiety disorder diagnoses. Although unadjusted analyses suggested a higher incidence of postpartum mood or anxiety disorders among patients continuing psychostimulants than those who discontinued (19.3% vs 12.8%; rate ratio 1.46, 95% CI, 1.17-1.83), this association was no longer observed after controlling for confounders. In adjusted analyses, continuation of psychostimulants during pregnancy was not associated with differences in postpartum mental health-related admissions (rate ratio 1.01, 95% CI, 0.59-1.71) or new mood or anxiety disorder diagnoses (rate ratio 1.30, 95% CI, 0.97-1.74). Preexisting mental health diagnoses (rate ratio 2.60, 95% CI, 1.76-3.90) and medical comorbidities (rate ratio 1.98, 95% CI, 1.33-2.93) were the strongest predictors of postpartum admissions.

Among individuals with ADHD adherent to psychostimulants before pregnancy, the continuation of medication during pregnancy was not associated with adverse postpartum mental health outcomes when compared with discontinuation of medication.