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Pregnant women
who take drugs like Ritalin and Concerta for attention deficit hyperactivity
disorder (ADHD) are more likely than those who don't to have babies with heart
deformities and other birth defects, a recent study suggests. Researchers
examined data on more than 1.8 million pregnancies in the U.S., including 2,072
women who used methylphenidate (Ritalin, Concerta, Daytrana) and 5,571 who took
an amphetamine (Adderall) during their first trimester.
Overall, women
who took methylphenidate were 11 percent more likely to have a baby with birth
defects and 28 percent more likely to have infants with heart malformations
than women who didn't take stimulants for ADHD during pregnancy. There was no
increased risk of birth defects in general or heart malformations specifically
with amphetamines like Adderall, the researchers found.
"Our
findings suggest that there might be a small increase in the risk of cardiac
malformations associated with intrauterine exposure to methylphenidate,"
said lead study author Krista Huybrechts of Harvard Medical School and Brigham
and Women's Hospital in Boston.
"Although
the absolute risk is small, it is nevertheless important evidence to consider
when weighing the potential risks and benefits of different treatment
strategies for ADHD in young women of reproductive age and in pregnant
women," Huybrechts said by email.
An estimated 3
percent of children, teens and adults have ADHD, researchers note in JAMA
Psychiatry. Stimulants like Adderall and Ritalin are among the most commonly
prescribed medications for the condition, and these drugs are increasingly
being used by women of childbearing age.
All of the women
in the current study had health insurance through Medicaid, the U.S. benefits
program for the poor. Among children of women who were not taking stimulants
for ADHD, 35 out of every 1,000 babies had birth defects, compared with 46 out
of every 1,000 infants born to women using drugs like Ritalin.
To assess
whether these results were unique to the U.S. or to women on Medicaid,
researchers also examined health registry data for more than 2.5 million
pregnancies in Denmark, Finland, Iceland, Norway and Sweden.
In the Nordic
data, drugs like Ritalin were also associated with a 28 percent higher risk of
heart malformations in babies. The study wasn't a controlled experiment
designed to prove whether or how specific ADHD drugs might cause birth defects.
Because the
study only included live births, it didn't explore whether the drugs might
increase the risks of severe birth defects that lead to miscarriage or
stillbirths or that prompt women to terminate pregnancies, the authors note.
"If a woman
has mild symptoms, it might be possible to avoid use of the medicine during
pregnancy," said Dr. William Cooper, a researcher at Vanderbilt University
Medical Center in Nashville, Tennessee, who wasn't involved in the study but
wrote an accompanying editorial.
"However,
if the woman has severe symptoms that interfere with her daily function, the
results of this study can help to guide decisions on whether to continue,"
Cooper said by email. It may also make sense for some women with ADHD to
consider stopping or changing medications when they're trying to conceive,
Huybrechts said.
"Considering
the high rate of unplanned pregnancies among young women, the potential for
accidental exposure is also very high,"Huybrechts said. "Although the
absolute risk is small, it is nevertheless important evidence to consider when
weighing the potential risks and benefits of different treatment strategies for
ADHD in young women of reproductive age and in pregnant women.