Obstetric Risk Associated With Stimulant Versus Nonstimulant Treatment During Pregnancy

Objective: To evaluate and compare the obstetric risks associated with stimulant and nonstimulant medication use during pregnancy.

Methods: This retrospective cohort study used TriNetX electronic health records from 894,986 pregnancies recorded between 2010 and 2023. Women aged 18-45 years were grouped by attention-deficit/hyperactivity disorder (ADHD) medication exposure during pregnancy: stimulant (n=3,465), nonstimulant (n=575), or no ADHD medication (n=890,946). Propensity score-based inverse probability of treatment weighting balanced demographic, substance use, medical, and mental health factors, including ADHD. Weighted logistic regression compared adverse pregnancy outcomes across groups.

Results: Stimulant and nonstimulant use during pregnancy were both associated with increased risk for several obstetric complications compared to no medication, with increased-risk odds ratios ranging from 1.21 to 1.85 for stimulants and 1.12 to 5.70 for nonstimulants. Compared with nonstimulants, stimulants were associated with higher odds of placenta previa and large for gestational age but lower odds of gestational diabetes, placental abruption, intrauterine growth restriction, and preterm delivery.

Conclusion: Stimulant and nonstimulant use during pregnancy were associated with increased obstetric risk. Given the observational electronic health record design, lack of an ADHD-unmedicated comparison group, and lack of adjustment for concomitant medication exposures, findings should be interpreted as potential safety signals rather than definitive causal estimates. Findings support individualized risk-benefit assessment and further research on ADHD treatment during pregnancy.