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Investigating maternal and neonatal health outcomes associated with continuing or ceasing dexamphetamine treatment for women with attention-deficit hyperactivity disorder during pregnancy: a retrospective cohort study
Purpose Attention-deficit hyperactivity disorder (ADHD) is becoming more commonly diagnosed in women, consequently, more women of reproductive age are taking ADHD medication, such as dexamphetamine. However, the safety associated with continuing or ceasing dexamphetamine during pregnancy is unclear....
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| Published in: | Archives of women's mental health 2024-10, Vol.27 (5), p.785-794 |
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| container_issue | 5 |
| container_start_page | 785 |
| container_title | Archives of women's mental health |
| container_volume | 27 |
| creator | Russell, Danielle J. Wyrwoll, Caitlin S. Preen, David B. Kelty, Erin |
| description | Purpose
Attention-deficit hyperactivity disorder (ADHD) is becoming more commonly diagnosed in women, consequently, more women of reproductive age are taking ADHD medication, such as dexamphetamine. However, the safety associated with continuing or ceasing dexamphetamine during pregnancy is unclear. This study investigates outcomes associated with the continuation of dexamphetamine during pregnancy compared to those who ceased or were unexposed.
Methods
A population-based retrospective cohort of women from Western Australia who had been dispensed dexamphetamine during pregnancy and gave birth between 2003 and 2018. Women had either continued to take dexamphetamine throughout pregnancy (continuers,
n
= 547) or ceased dexamphetamine before the end of the second trimester (ceasers,
n
= 297). Additionally, a matched (1:1) comparison group of women who were dispensed an ADHD medication prior to pregnancy but not during pregnancy (unexposed) was included in the study (
n
= 844). Multivariable generalised linear models were used to compare maternal and neonatal health outcomes.
Results
Compared to continuers, ceasers had greater odds of threatened abortion (OR: 2.28; 95%CI: 1.00, 5.15;
p
= 0.049). The unexposed had some benefits compared to the continuers, which included lower risk of preeclampsia (OR: 0.58; 95%CI: 0.35, 0.97;
p
= 0.037), hypertension (OR: 0.32; 95%CI: 0.11, 0.93;
p
= 0.036), postpartum haemorrhage (OR: 0.57; 95%CI: 0.41, 0.80;
p
= 0.001), neonatal special care unit admittance (OR: 0.16; 95%CI: 0.12, 0.20;
p
|
| doi_str_mv | 10.1007/s00737-024-01450-4 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_11405422</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2934273073</sourcerecordid><originalsourceid>FETCH-LOGICAL-c426t-6fe7223cb6cbb6070f6b8c5a3eaf73082c8ee27166664d948655704f09c1d6443</originalsourceid><addsrcrecordid>eNp9kstu1TAQhiMEouXAC7BAltiwCfiWGxtUVVwqVWIDa2uOPTlxldjBdk45j9q3qdNTymVBFs44_ub3TOYvipeMvmWUNu9iXkRTUi5LymRFS_moOGVSVCVjlD--i2XJWlafFM9ivKKUVl0nnxYnopVc8kqeFjcXbo8x2R0k63ZkgoTBwUjAGeLQO0h5MyCMaSB-SdpPGAnE6LXNqCHXNh9o73L2sgr4QDRCXEODP2GaB0wwWYckBYQ0oUukz9B1FnLHbEgpf7XelQZ7q20iw2HGADrZvU0HYmz0wWAgZgmr7hxw58Dpw3sCJGAKPs64wpgLGXxIJKbFHJ4XT3oYI764f2-K758-fjv_Ul5-_XxxfnZZasnrVNY9NpwLva31dlvThvb1ttUVCIS-EbTlukXkDavzI00n27qqGip72mlmainFpvhw1J2X7YRG514CjGoOdoJwUB6s-vvE2UHt_F4xJmkl892b4s29QvA_ljwNNdmocRwhT2CJindC8lxLIzL6-h_0yi_rwKISjFaV7FraZoofKZ3_TQzYP1TDqFqto47WUdk66s46au3j1Z99PKT88koGxBGI8zoHDL_v_o_sLcGs10k</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>3105549808</pqid></control><display><type>article</type><title>Investigating maternal and neonatal health outcomes associated with continuing or ceasing dexamphetamine treatment for women with attention-deficit hyperactivity disorder during pregnancy: a retrospective cohort study</title><source>Springer Nature</source><creator>Russell, Danielle J. ; Wyrwoll, Caitlin S. ; Preen, David B. ; Kelty, Erin</creator><creatorcontrib>Russell, Danielle J. ; Wyrwoll, Caitlin S. ; Preen, David B. ; Kelty, Erin</creatorcontrib><description>Purpose
Attention-deficit hyperactivity disorder (ADHD) is becoming more commonly diagnosed in women, consequently, more women of reproductive age are taking ADHD medication, such as dexamphetamine. However, the safety associated with continuing or ceasing dexamphetamine during pregnancy is unclear. This study investigates outcomes associated with the continuation of dexamphetamine during pregnancy compared to those who ceased or were unexposed.
Methods
A population-based retrospective cohort of women from Western Australia who had been dispensed dexamphetamine during pregnancy and gave birth between 2003 and 2018. Women had either continued to take dexamphetamine throughout pregnancy (continuers,
n
= 547) or ceased dexamphetamine before the end of the second trimester (ceasers,
n
= 297). Additionally, a matched (1:1) comparison group of women who were dispensed an ADHD medication prior to pregnancy but not during pregnancy (unexposed) was included in the study (
n
= 844). Multivariable generalised linear models were used to compare maternal and neonatal health outcomes.
Results
Compared to continuers, ceasers had greater odds of threatened abortion (OR: 2.28; 95%CI: 1.00, 5.15;
p
= 0.049). The unexposed had some benefits compared to the continuers, which included lower risk of preeclampsia (OR: 0.58; 95%CI: 0.35, 0.97;
p
= 0.037), hypertension (OR: 0.32; 95%CI: 0.11, 0.93;
p
= 0.036), postpartum haemorrhage (OR: 0.57; 95%CI: 0.41, 0.80;
p
= 0.001), neonatal special care unit admittance (OR: 0.16; 95%CI: 0.12, 0.20;
p
< 0.001) and fetal distress (OR: 0.73; 95%CI: 0.54, 0.99;
p
= 0.042).
Conclusion
Continuing dexamphetamine throughout pregnancy was not associated with an increase in adverse neonatal and maternal health outcomes compared to ceasing. Ceasing dexamphetamine during pregnancy was associated with increased odds of threatened abortion compared with continuing dexamphetamine. However, this is something that requires further investigation due to the small sample size, difficulties examining timing, and the inability to examine spontaneous abortions. The unexposed showed some benefits compared to the continuers, suggesting that where possible the cessation of dexamphetamine prior to pregnancy may be advisable.</description><identifier>ISSN: 1434-1816</identifier><identifier>ISSN: 1435-1102</identifier><identifier>EISSN: 1435-1102</identifier><identifier>DOI: 10.1007/s00737-024-01450-4</identifier><identifier>PMID: 38424254</identifier><language>eng</language><publisher>Vienna: Springer Vienna</publisher><subject>Abortion ; Adult ; Attention Deficit Disorder with Hyperactivity - drug therapy ; Attention deficit hyperactivity disorder ; Central Nervous System Stimulants - administration & dosage ; Central Nervous System Stimulants - adverse effects ; Central Nervous System Stimulants - therapeutic use ; Cohort Studies ; Dextroamphetamine - adverse effects ; Dextroamphetamine - therapeutic use ; Female ; Fetuses ; Hemorrhage ; Humans ; Infant Health ; Infant, Newborn ; Medicine ; Medicine & Public Health ; Neonates ; Original ; Original Article ; Population studies ; Pre-eclampsia ; Pregnancy ; Pregnancy complications ; Pregnancy Complications - drug therapy ; Pregnancy Outcome - epidemiology ; Psychiatry ; Psychotherapy ; Retrospective Studies ; Western Australia - epidemiology ; Womens health</subject><ispartof>Archives of women's mental health, 2024-10, Vol.27 (5), p.785-794</ispartof><rights>The Author(s) 2024</rights><rights>2024. The Author(s).</rights><rights>The Author(s) 2024. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>The Author(s) 2024 2024</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c426t-6fe7223cb6cbb6070f6b8c5a3eaf73082c8ee27166664d948655704f09c1d6443</cites><orcidid>0000-0002-5746-5680 ; 0000-0002-3366-4415 ; 0000-0002-0841-2216 ; 0000-0002-2982-2169</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38424254$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Russell, Danielle J.</creatorcontrib><creatorcontrib>Wyrwoll, Caitlin S.</creatorcontrib><creatorcontrib>Preen, David B.</creatorcontrib><creatorcontrib>Kelty, Erin</creatorcontrib><title>Investigating maternal and neonatal health outcomes associated with continuing or ceasing dexamphetamine treatment for women with attention-deficit hyperactivity disorder during pregnancy: a retrospective cohort study</title><title>Archives of women's mental health</title><addtitle>Arch Womens Ment Health</addtitle><addtitle>Arch Womens Ment Health</addtitle><description>Purpose
Attention-deficit hyperactivity disorder (ADHD) is becoming more commonly diagnosed in women, consequently, more women of reproductive age are taking ADHD medication, such as dexamphetamine. However, the safety associated with continuing or ceasing dexamphetamine during pregnancy is unclear. This study investigates outcomes associated with the continuation of dexamphetamine during pregnancy compared to those who ceased or were unexposed.
Methods
A population-based retrospective cohort of women from Western Australia who had been dispensed dexamphetamine during pregnancy and gave birth between 2003 and 2018. Women had either continued to take dexamphetamine throughout pregnancy (continuers,
n
= 547) or ceased dexamphetamine before the end of the second trimester (ceasers,
n
= 297). Additionally, a matched (1:1) comparison group of women who were dispensed an ADHD medication prior to pregnancy but not during pregnancy (unexposed) was included in the study (
n
= 844). Multivariable generalised linear models were used to compare maternal and neonatal health outcomes.
Results
Compared to continuers, ceasers had greater odds of threatened abortion (OR: 2.28; 95%CI: 1.00, 5.15;
p
= 0.049). The unexposed had some benefits compared to the continuers, which included lower risk of preeclampsia (OR: 0.58; 95%CI: 0.35, 0.97;
p
= 0.037), hypertension (OR: 0.32; 95%CI: 0.11, 0.93;
p
= 0.036), postpartum haemorrhage (OR: 0.57; 95%CI: 0.41, 0.80;
p
= 0.001), neonatal special care unit admittance (OR: 0.16; 95%CI: 0.12, 0.20;
p
< 0.001) and fetal distress (OR: 0.73; 95%CI: 0.54, 0.99;
p
= 0.042).
Conclusion
Continuing dexamphetamine throughout pregnancy was not associated with an increase in adverse neonatal and maternal health outcomes compared to ceasing. Ceasing dexamphetamine during pregnancy was associated with increased odds of threatened abortion compared with continuing dexamphetamine. However, this is something that requires further investigation due to the small sample size, difficulties examining timing, and the inability to examine spontaneous abortions. The unexposed showed some benefits compared to the continuers, suggesting that where possible the cessation of dexamphetamine prior to pregnancy may be advisable.</description><subject>Abortion</subject><subject>Adult</subject><subject>Attention Deficit Disorder with Hyperactivity - drug therapy</subject><subject>Attention deficit hyperactivity disorder</subject><subject>Central Nervous System Stimulants - administration & dosage</subject><subject>Central Nervous System Stimulants - adverse effects</subject><subject>Central Nervous System Stimulants - therapeutic use</subject><subject>Cohort Studies</subject><subject>Dextroamphetamine - adverse effects</subject><subject>Dextroamphetamine - therapeutic use</subject><subject>Female</subject><subject>Fetuses</subject><subject>Hemorrhage</subject><subject>Humans</subject><subject>Infant Health</subject><subject>Infant, Newborn</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Neonates</subject><subject>Original</subject><subject>Original Article</subject><subject>Population studies</subject><subject>Pre-eclampsia</subject><subject>Pregnancy</subject><subject>Pregnancy complications</subject><subject>Pregnancy Complications - drug therapy</subject><subject>Pregnancy Outcome - epidemiology</subject><subject>Psychiatry</subject><subject>Psychotherapy</subject><subject>Retrospective Studies</subject><subject>Western Australia - epidemiology</subject><subject>Womens health</subject><issn>1434-1816</issn><issn>1435-1102</issn><issn>1435-1102</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><recordid>eNp9kstu1TAQhiMEouXAC7BAltiwCfiWGxtUVVwqVWIDa2uOPTlxldjBdk45j9q3qdNTymVBFs44_ub3TOYvipeMvmWUNu9iXkRTUi5LymRFS_moOGVSVCVjlD--i2XJWlafFM9ivKKUVl0nnxYnopVc8kqeFjcXbo8x2R0k63ZkgoTBwUjAGeLQO0h5MyCMaSB-SdpPGAnE6LXNqCHXNh9o73L2sgr4QDRCXEODP2GaB0wwWYckBYQ0oUukz9B1FnLHbEgpf7XelQZ7q20iw2HGADrZvU0HYmz0wWAgZgmr7hxw58Dpw3sCJGAKPs64wpgLGXxIJKbFHJ4XT3oYI764f2-K758-fjv_Ul5-_XxxfnZZasnrVNY9NpwLva31dlvThvb1ttUVCIS-EbTlukXkDavzI00n27qqGip72mlmainFpvhw1J2X7YRG514CjGoOdoJwUB6s-vvE2UHt_F4xJmkl892b4s29QvA_ljwNNdmocRwhT2CJindC8lxLIzL6-h_0yi_rwKISjFaV7FraZoofKZ3_TQzYP1TDqFqto47WUdk66s46au3j1Z99PKT88koGxBGI8zoHDL_v_o_sLcGs10k</recordid><startdate>20241001</startdate><enddate>20241001</enddate><creator>Russell, Danielle J.</creator><creator>Wyrwoll, Caitlin S.</creator><creator>Preen, David B.</creator><creator>Kelty, Erin</creator><general>Springer Vienna</general><general>Springer Nature B.V</general><scope>C6C</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TK</scope><scope>ASE</scope><scope>FPQ</scope><scope>K6X</scope><scope>K9.</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-5746-5680</orcidid><orcidid>https://orcid.org/0000-0002-3366-4415</orcidid><orcidid>https://orcid.org/0000-0002-0841-2216</orcidid><orcidid>https://orcid.org/0000-0002-2982-2169</orcidid></search><sort><creationdate>20241001</creationdate><title>Investigating maternal and neonatal health outcomes associated with continuing or ceasing dexamphetamine treatment for women with attention-deficit hyperactivity disorder during pregnancy: a retrospective cohort study</title><author>Russell, Danielle J. ; Wyrwoll, Caitlin S. ; Preen, David B. ; Kelty, Erin</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c426t-6fe7223cb6cbb6070f6b8c5a3eaf73082c8ee27166664d948655704f09c1d6443</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Abortion</topic><topic>Adult</topic><topic>Attention Deficit Disorder with Hyperactivity - drug therapy</topic><topic>Attention deficit hyperactivity disorder</topic><topic>Central Nervous System Stimulants - administration & dosage</topic><topic>Central Nervous System Stimulants - adverse effects</topic><topic>Central Nervous System Stimulants - therapeutic use</topic><topic>Cohort Studies</topic><topic>Dextroamphetamine - adverse effects</topic><topic>Dextroamphetamine - therapeutic use</topic><topic>Female</topic><topic>Fetuses</topic><topic>Hemorrhage</topic><topic>Humans</topic><topic>Infant Health</topic><topic>Infant, Newborn</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Neonates</topic><topic>Original</topic><topic>Original Article</topic><topic>Population studies</topic><topic>Pre-eclampsia</topic><topic>Pregnancy</topic><topic>Pregnancy complications</topic><topic>Pregnancy Complications - drug therapy</topic><topic>Pregnancy Outcome - epidemiology</topic><topic>Psychiatry</topic><topic>Psychotherapy</topic><topic>Retrospective Studies</topic><topic>Western Australia - epidemiology</topic><topic>Womens health</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Russell, Danielle J.</creatorcontrib><creatorcontrib>Wyrwoll, Caitlin S.</creatorcontrib><creatorcontrib>Preen, David B.</creatorcontrib><creatorcontrib>Kelty, Erin</creatorcontrib><collection>Springer_OA刊</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Neurosciences Abstracts</collection><collection>British Nursing Index</collection><collection>British Nursing Index (BNI) (1985 to Present)</collection><collection>British Nursing Index</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Archives of women's mental health</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Russell, Danielle J.</au><au>Wyrwoll, Caitlin S.</au><au>Preen, David B.</au><au>Kelty, Erin</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Investigating maternal and neonatal health outcomes associated with continuing or ceasing dexamphetamine treatment for women with attention-deficit hyperactivity disorder during pregnancy: a retrospective cohort study</atitle><jtitle>Archives of women's mental health</jtitle><stitle>Arch Womens Ment Health</stitle><addtitle>Arch Womens Ment Health</addtitle><date>2024-10-01</date><risdate>2024</risdate><volume>27</volume><issue>5</issue><spage>785</spage><epage>794</epage><pages>785-794</pages><issn>1434-1816</issn><issn>1435-1102</issn><eissn>1435-1102</eissn><abstract>Purpose
Attention-deficit hyperactivity disorder (ADHD) is becoming more commonly diagnosed in women, consequently, more women of reproductive age are taking ADHD medication, such as dexamphetamine. However, the safety associated with continuing or ceasing dexamphetamine during pregnancy is unclear. This study investigates outcomes associated with the continuation of dexamphetamine during pregnancy compared to those who ceased or were unexposed.
Methods
A population-based retrospective cohort of women from Western Australia who had been dispensed dexamphetamine during pregnancy and gave birth between 2003 and 2018. Women had either continued to take dexamphetamine throughout pregnancy (continuers,
n
= 547) or ceased dexamphetamine before the end of the second trimester (ceasers,
n
= 297). Additionally, a matched (1:1) comparison group of women who were dispensed an ADHD medication prior to pregnancy but not during pregnancy (unexposed) was included in the study (
n
= 844). Multivariable generalised linear models were used to compare maternal and neonatal health outcomes.
Results
Compared to continuers, ceasers had greater odds of threatened abortion (OR: 2.28; 95%CI: 1.00, 5.15;
p
= 0.049). The unexposed had some benefits compared to the continuers, which included lower risk of preeclampsia (OR: 0.58; 95%CI: 0.35, 0.97;
p
= 0.037), hypertension (OR: 0.32; 95%CI: 0.11, 0.93;
p
= 0.036), postpartum haemorrhage (OR: 0.57; 95%CI: 0.41, 0.80;
p
= 0.001), neonatal special care unit admittance (OR: 0.16; 95%CI: 0.12, 0.20;
p
< 0.001) and fetal distress (OR: 0.73; 95%CI: 0.54, 0.99;
p
= 0.042).
Conclusion
Continuing dexamphetamine throughout pregnancy was not associated with an increase in adverse neonatal and maternal health outcomes compared to ceasing. Ceasing dexamphetamine during pregnancy was associated with increased odds of threatened abortion compared with continuing dexamphetamine. However, this is something that requires further investigation due to the small sample size, difficulties examining timing, and the inability to examine spontaneous abortions. The unexposed showed some benefits compared to the continuers, suggesting that where possible the cessation of dexamphetamine prior to pregnancy may be advisable.</abstract><cop>Vienna</cop><pub>Springer Vienna</pub><pmid>38424254</pmid><doi>10.1007/s00737-024-01450-4</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0002-5746-5680</orcidid><orcidid>https://orcid.org/0000-0002-3366-4415</orcidid><orcidid>https://orcid.org/0000-0002-0841-2216</orcidid><orcidid>https://orcid.org/0000-0002-2982-2169</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1434-1816 |
| ispartof | Archives of women's mental health, 2024-10, Vol.27 (5), p.785-794 |
| issn | 1434-1816 1435-1102 1435-1102 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_11405422 |
| source | Springer Nature |
| subjects | Abortion Adult Attention Deficit Disorder with Hyperactivity - drug therapy Attention deficit hyperactivity disorder Central Nervous System Stimulants - administration & dosage Central Nervous System Stimulants - adverse effects Central Nervous System Stimulants - therapeutic use Cohort Studies Dextroamphetamine - adverse effects Dextroamphetamine - therapeutic use Female Fetuses Hemorrhage Humans Infant Health Infant, Newborn Medicine Medicine & Public Health Neonates Original Original Article Population studies Pre-eclampsia Pregnancy Pregnancy complications Pregnancy Complications - drug therapy Pregnancy Outcome - epidemiology Psychiatry Psychotherapy Retrospective Studies Western Australia - epidemiology Womens health |
| title | Investigating maternal and neonatal health outcomes associated with continuing or ceasing dexamphetamine treatment for women with attention-deficit hyperactivity disorder during pregnancy: a retrospective cohort study |
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