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Pharmacological Treatment of Attention Deficit Hyperactivity Disorder During Pregnancy and Lactation

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  • Theme: The Use of Pharmaceuticals in Pregnancy and Lactation
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Abstract

Introduction

Attention deficit/hyperactivity disorder (ADHD) is a neurobehavioral problem found in 2–5% of adults. Stimulants and drugs that affect the dopaminergic, noradrenergic and/or serotonergic systems are effective treatment and are increasingly prescribed to women at child bearing age. It is consequently important that reliable information on the safety of these drugs in pregnancy is available so that appropriate therapeutic choices can be made.

Results

The data on stimulants (methylphenidate and amphetamines) are generally showing that there is no increase in the rate of major congenital anomalies. There are very little data on the use of atomoxetine and guanfacine in pregnancy. There are no data on the use of clonidine for ADHD but the data on its use as an antihypertensive drug have not revealed any serious adverse effect. Bupropion, when used as an antidepressant, does not seem to increase the rate of congenital anomalies. There are practically no data on the possible long-term neurodevelopmental effects of any of these drugs. Most of them are secreted in human milk, but the concentrations in infant’s blood, except for clonidine and amphetamines, have been very low. Breast feeding with clonidine and amphetamines is therefore contraindicated, but there seems to be no safety concerns for the other drugs.

Conclusion

The drugs used for the treatment of ADHD are apparently not teratogenic, but due to paucity of data, especially on the long-term neurodevelopmental outcome, the treating physician should reconsider the need of treatment during pregnancy. If needed, methylphenidate, amphetamines and bupropion are preferred drugs.

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Abbreviations

ADHD:

Attention deficit/Hyperactivity disorder

aOR:

Adjusted odds ratio

CI:

Confidence interval

CPTs:

Computerized attentional performance tests

DSM 5:

Diagnostic statistical manual 5

DTI:

Diffusion tensor imaging

MDMA:

Methylenedeoxymetamphetamine

MRI:

Magnetic resonance imaging

SNRIs:

Serotonin norepinephrine reuptake inhibitors

OR:

Odds ratio

Ritalin IR:

Ritalin immediate release

Ritalin LA:

Ritalin long acting

Ritalin SR:

Ritalin sustained release

SGA:

Small for gestational age

SSRIs:

Serotonin reuptake inhibitors

VSD:

Ventricular septal defect

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  1. Laboratory of Teratology, Department of Medical Neurobiology, Israel Canada Research Institute, Hebrew University Hadassah Medical School, 91120, Jerusalem, Israel

    Asher Ornoy

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Ornoy, A. Pharmacological Treatment of Attention Deficit Hyperactivity Disorder During Pregnancy and Lactation. Pharm Res 35, 46 (2018). https://doi.org/10.1007/s11095-017-2323-z

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