ADHD Drug Exposure in Utero Increases Heart Defect Risk

Intrauterine exposure to methylphenidate during the first trimester of pregnancy was linked with a small increase in an infant’s risk of heart defects, according to research published online in JAMA Psychiatry.

“Our findings suggest a small increase in the risk of cardiac malformations associated with first-trimester exposure to methylphenidate, but not to amphetamines,” said corresponding author Krista Huybrechts, PhD, of Brigham and Women’s Hospital in Boston, Massachusetts. “This information may be important to patients and their physicians as they weigh the risks and benefits of alternative treatment strategies for attention deficit/hyperactivity disorder (ADHD).”

Referencing rapid growth in the use of stimulant medications during pregnancy and among women of reproductive age, researchers said they conducted the study to better understand the safety of exposure to ADHD drugs during pregnancy. The study tapped data on 1.8 million US pregnancies from the International Pregnancy Safety Study consortium, including the more than 2700 women who filled a prescription for methylphenidate and the more than 5500 women who filled a prescription for amphetamines during the first trimester. Researchers validated their findings using data from among 2.5 million pregnancies from Nordic registries.

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Based on both populations, the study suggested a 28% increased risk of cardiac malformations—or 3 additional infants born with heart defects per every 1,000 women—with exposure to methylphenidate during the first trimester. Researchers found no such association with amphetamines.

Neither methylphenidate nor amphetamines were linked with congenital birth defects overall.

“Our study markedly expands the evidence base regarding the safety of methylphenidate use in pregnancy,” said Dr. Huybrechts. “Although the absolute risk is small, it is nevertheless important evidence to consider when treating young women of reproductive age and pregnant women.”

—Jolynn Tumolo

References

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. 2017 December 13;[Epub ahead of print].

Study explores use of ADHD medications during pregnancy and risk of birth defects [press release]. Boston, Massachusetts: l; December 13, 2017.