Comparative Risks of Pregnancy Complications in Women Prescribed Psychostimulants or Atomoxetine During Pregnancy Following Pre-Pregnancy Stimulant Use.

Abstract

Objective: Prescription stimulants are commonly used to manage attention deficit hyperactivity disorder among women of reproductive age, yet their safety during pregnancy remains unclear. This study leveraged large-scale electronic health record data to assess whether use of these medications during pregnancy was associated with adverse pregnancy outcomes and to support clinicians in making informed treatment decisions.

Methods: The study included adult women with deliveries from 2010 to 2022 who had two or more stimulant prescriptions before pregnancy. Participants were categorized into three mutually exclusive groups: stimulant, atomoxetine, and control (neither medication during pregnancy). The outcomes of interest included prenatal maternal, placental, fetal growth, labor-delivery, and birth-related complications occurring during pregnancy. Propensity score matching analysis was applied to reduce confounding effects in patient baseline characteristics, followed by logistic regression to assess the likelihood of each adverse pregnancy outcome type.

Results: There were 32,152 pregnant women in the analysis, including 8394 (26.1%) prescribed stimulants, 405 (1.3%) prescribed atomoxetine, and 23,353 (72.7%) controls during pregnancy. The stimulant group was 1.2-3.1 times more likely to develop prenatal maternal, placental, and birth-related complications than the atomoxetine and control groups, while the atomoxetine group was 1.1-2.3 times more likely to experience fetal growth abnormality and labor-delivery issues than the control groups. Interestingly, the stimulant group showed 54% lower odds of fetal growth restriction than the atomoxetine group.

Conclusions: This study highlighted differential risk profiles between stimulant and non-stimulant therapies, contributing evidence that informs future research on perinatal safety.

Relevance to clinical practice: The distinct risk profiles identified for stimulant and atomoxetine therapies underscore the need for personalized treatment decisions during pregnancy.