Attention-Deficit/Hyperactivity Disorder Medication Use in Pregnancy and Risk of Preterm Birth: A Population-Based Cohort Study.

IF 2.7 3区 医学 Q2 OBSTETRICS & GYNECOLOGY
Chaitra Srinivas, Øystein Karlstad, Hein Stigum, Kari Furu, Carolyn E Cesta, Johan Reutfors, Jennifer A Hutcheon, Jacqueline M Cohen
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引用次数: 0

Abstract

Background: Medication use during pregnancy for attention-deficit/hyperactivity disorder (ADHD) is increasing, but evidence on its safety in pregnancy for foetal health is limited, with little attention to time-related biases in observational research.

Objective: To determine the association between ADHD medication use in early and late pregnancy and the risk of preterm birth.

Methods: This population-based cohort study utilised data from national registers, including records on births, prescription medications, specialist healthcare visits, hospitalisations and educational attainment, to account for relevant potential confounders. We included singleton births delivered between 22 and 44 gestational weeks among pregnant individuals with ADHD medication use in the year before conception from Norway (2009-2020) and Sweden (2007-2019). ADHD medications (amphetamine, dexamphetamine, methylphenidate, atomoxetine, lisdexamfetamine and guanfacine) were assessed during early (conception to 21 gestational weeks) and late pregnancy (22-36 gestational weeks). The main outcome was preterm birth, defined as a live birth before 37 completed weeks of pregnancy. Risk ratios (RR) and hazard ratios (HR) with 95% confidence intervals (CI) were estimated using log-binomial regression and flexible parametric survival modelling to determine the risk of preterm birth in early and late pregnancy, respectively.

Results: Among 11,075 pregnancies, early pregnancy ADHD medication use was associated with higher preterm birth risk with ≥ 2 filled prescriptions (aRR 1.29, 95% CI 1.08, 1.53), but not as ≥ 1 prescription (aRR 1.08, 95% CI 0.93, 1.25). Any medication use in late pregnancy increased preterm birth risk (aHR 1.15, 95% CI 0.95, 1.39). For every 30 days of cumulative exposure to ADHD medication, the risk of preterm birth increased in late pregnancy (aHR 1.07, 95% CI 1.02, 1.12), but not in early pregnancy (aHR 1.01, 95% CI 0.97, 1.05).

Conclusions: ADHD medication may modestly increase the risk of preterm birth, especially with atomoxetine early and methylphenidate late in pregnancy, and with longer durations of use.

孕期注意缺陷/多动障碍药物使用与早产风险:一项基于人群的队列研究
背景:妊娠期治疗注意力缺陷/多动障碍(ADHD)的药物使用正在增加,但关于其在妊娠期对胎儿健康的安全性的证据有限,在观察性研究中很少关注与时间相关的偏差。目的:探讨妊娠早期和晚期ADHD药物使用与早产风险的关系。方法:这项以人群为基础的队列研究利用了来自国家登记册的数据,包括出生记录、处方药、专科医疗就诊、住院和教育程度,以解释相关的潜在混杂因素。我们纳入了挪威(2009-2020年)和瑞典(2007-2019年)怀孕前一年使用ADHD药物的孕妇中22至44孕周分娩的单胎婴儿。ADHD药物(安非他命、右安非他命、哌醋甲酯、托莫西汀、利地安非他命和胍法辛)在妊娠早期(受孕至21孕周)和妊娠晚期(22-36孕周)进行评估。主要结果是早产,定义为在怀孕37周之前活产。分别使用对数二项回归和灵活参数生存模型估计95%置信区间(CI)的风险比(RR)和风险比(HR),以确定妊娠早期和晚期早产的风险。结果:在11,075例妊娠中,处方≥2张的妊娠早期ADHD药物使用与较高的早产风险相关(aRR 1.29, 95% CI 1.08, 1.53),但处方≥1张的妊娠早期ADHD药物使用与较高的早产风险相关(aRR 1.08, 95% CI 0.93, 1.25)。妊娠后期使用任何药物都会增加早产风险(aHR 1.15, 95% CI 0.95, 1.39)。对于每30天的ADHD药物累积暴露,妊娠后期早产的风险增加(aHR 1.07, 95% CI 1.02, 1.12),但妊娠早期没有(aHR 1.01, 95% CI 0.97, 1.05)。结论:ADHD药物可能会适度增加早产的风险,特别是在妊娠早期使用托莫西汀和妊娠晚期使用哌甲酯,并且使用时间较长。
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来源期刊
CiteScore
5.40
自引率
7.10%
发文量
84
审稿时长
1 months
期刊介绍: Paediatric and Perinatal Epidemiology crosses the boundaries between the epidemiologist and the paediatrician, obstetrician or specialist in child health, ensuring that important paediatric and perinatal studies reach those clinicians for whom the results are especially relevant. In addition to original research articles, the Journal also includes commentaries, book reviews and annotations.
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