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PSYCHOPHARMACOLOGY
Risk of Congenital Malformations With Stimulant Use During Pregnancy
February 16, 2018   

In a recent cohort study from the International Pregnancy Safety Consortium the relationship between intrauterine exposure to stimulants, such as methylphenidate and amphetamine, and risk of congenital abnormalities. A total of 1,813,894 publicly insured pregnancies in the United States, and 2,560,069 pregnancies in 5 Nordic countries ending in live births were included. Relative risks were examined, accounting for underlying psychiatric disorders and other potential confounders. Relative risk estimates were pooled for all data using a fixed-effects meta-analytic approach. The analysis focused on exposure to stimulants dispensed during the first trimester, and any effects on major congential malformations and cardiac malformations. In the US data, the adjusted relative risks for methylphenidate were 1.11 (95% CI, 0.91-1.35) for any malformation and 1.28 (95% CI, 0.94-1.74) for cardiac formations. No increased risks were observed for amphetamines. Similar results were detected in the Nordic population. Results suggest that there is a small increase in the risk of cardiac malformations associated with intrauterine exposure to methylphenidate, but not to amphetamines. This information may be beneficial for considering alternative treatment strategies for attention deficit/hyperactivity disorders in women of reproductive age and during early pregnancy.

Reference

Huybrechts KF, Bröms G, Christensen LB, et al. Association Between Methylphenidate and Amphetamine Use in Pregnancy and Risk of Congenital Malformations: A Cohort Study From the International Pregnancy Safety Study Consortium. JAMA Psychiatry. 2018;75(2):167-175.Abstract.


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