Advertisement

CNS Drugs

, Volume 32, Issue 4, pp 377–386 | Cite as

Perinatal Outcomes of Women Diagnosed with Attention-Deficit/Hyperactivity Disorder: An Australian Population-Based Cohort Study

  • Alison S. PoultonEmail author
  • Bruce Armstrong
  • Ralph K. Nanan
Original Research Article

Abstract

Background

Attention-deficit/hyperactivity disorder (ADHD) is common and may require treatment in adulthood. We aimed to investigate the treatment patterns and perinatal outcomes of women with any history of stimulant treatment for ADHD.

Methods

We used health records of the New South Wales (NSW, Australia) population to compare perinatal outcomes of women treated with stimulants (dexamphetamine or methylphenidate) for ADHD from 1982 to 2012 who gave birth between 1994 and 2012, with perinatal outcomes of women with no known ADHD or stimulant treatment (comparison cohort). Five comparison women, matched by maternal age and infant year of birth, were selected for each treated woman. Pregnancy outcome odds ratios in the two groups were adjusted for confounders including maternal age and smoking.

Results

Of 5056 women treated for ADHD with stimulant medication, 3351 (66.3%) had stimulant treatment documented before the index pregnancy but not within 1 year before the expected date of delivery, 175 (3.5%) had stimulant treatment before and possibly during pregnancy (stimulant prescription within the 12 months directly before the expected date of the index birth and earlier), and 1530 (30.2%) had no stimulant treatment until after the index pregnancy. Treatment for ADHD at any time (before, before and during and only after the index pregnancy) was associated with reduced likelihood of spontaneous labour—odds ratios (ORs) 0.7 [0.7, 0.8], 0.7 [0.5, 0.9], and 0.7 [0.7, 0.8], respectively—and increased risk of caesarean delivery (1.2 [1.1, 1.3], 1.3 [0.9, 1.8], 1.3 [1.1, 1.4]); active neonatal resuscitation (1.2 [1.0, 1.3], 1.7 [1.1, 2.7], 1.3 [1.0, 1.7]); and neonatal admission > 4 h (1.2 [1.1, 1.3], 1.7 [1.2, 2.4], 1.2 [1.0, 1.4]). Treatment before or before and during pregnancy was, in addition, associated with increased risk of pre-eclampsia (1.2 [1.0, 1.4], 1.5 [0.8, 2.6]); preterm birth < 37 weeks (1.2 [1.0, 1.3], 1.4 [0.9, 2.3]); and 1-min Apgar < 7 (1.2 [1.1, 1.3], 2.0 [1.4, 2.9]). Stimulant prescribing was low during pregnancy (3.5% of women received such a prescription) and dropped during the 12 months before the due date from an average of 24.7 prescriptions per month in the first 6 months to 4.5 per month in the final 6 months.

Conclusions

Compared with no treatment, ADHD stimulant treatment at any time was associated with small increases in the risk of some adverse pregnancy outcomes; treatment before, or before and during pregnancy, was associated with additional adverse outcomes, even after a treatment-free period of several years. None of these associations can be confidently attributed to stimulant treatment; in all cases ADHD per se or correlates of it could be responsible for the association.

Notes

Acknowledgements

We would like to thank the custodians of the NSW Ministry of Health Pharmaceutical Services Drugs of Addiction database and the NSW Perinatal Data Collection for making the data available for this study, and Ms Katie Irvine, Manager of the Centre for Health Record Linkage, Sydney for advice on the study design and use of linked records.

Compliance with Ethical Standards

Funding

The study was funded by the Australian Women and Children’s Research Foundation (OZWAC). The funder had no role in the study design, analysis or interpretation, the writing of the report or the decision to submit for publication.

Conflict of interest

Dr Poulton reports personal fees and non-financial support from Shire Australia outside the submitted work and shares in GSK; Prof. Armstrong and Prof. Nanan report no conflicts of interest.

References

  1. 1.
    Chang CK, Hayes RD, Perera G, Broadbent MT, Fernandes AC, Lee WE, et al. Life expectancy at birth for people with serious mental illness and other major disorders from a secondary mental health care case register in London. PLoS One. 2011;6(5):e19590.  https://doi.org/10.1371/journal.pone.0019590.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Lawrence D, Hancock KJ, Kisely S. The gap in life expectancy from preventable physical illness in psychiatric patients in Western Australia: retrospective analysis of population based registers. BMJ. 2013;346:f2539.  https://doi.org/10.1136/bmj.f2539.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Ban L, Tata LJ, West J, Fiaschi L, Gibson JE. Live and non-live pregnancy outcomes among women with depression and anxiety: a population-based study. PLoS One. 2012;7(8):e43462.  https://doi.org/10.1371/journal.pone.0043462.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Boden R, Lundgren M, Brandt L, Reutfors J, Andersen M, Kieler H. Risks of adverse pregnancy and birth outcomes in women treated or not treated with mood stabilisers for bipolar disorder: population based cohort study. BMJ. 2012;345:e7085.  https://doi.org/10.1136/bmj.e7085.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Cortese S, Moreira-Maia CR, St Fleur D, Morcillo-Penalver C, Rohde LA, Faraone SV. Association between ADHD and obesity: a systematic review and meta-analysis. Am J Psychiatry. 2016;173(1):34–43.  https://doi.org/10.1176/appi.ajp.2015.15020266.CrossRefPubMedGoogle Scholar
  6. 6.
    Evans-Lacko S, Knapp M, McCrone P, Thornicroft G, Mojtabai R. The mental health consequences of the recession: economic hardship and employment of people with mental health problems in 27 European countries. PLoS One. 2013;8(7):e69792.  https://doi.org/10.1371/journal.pone.0069792.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Lawrence D, Mitrou F, Zubrick SR. Smoking and mental illness: results from population surveys in Australia and the United States. BMC Public Health. 2009;9:285.  https://doi.org/10.1186/1471-2458-9-285.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    de Zwaan M, Gruss B, Muller A, Graap H, Martin A, Glaesmer H, et al. The estimated prevalence and correlates of adult ADHD in a German community sample. Eur Arch Psychiatry Clin Neurosci. 2012;262(1):79–86.  https://doi.org/10.1007/s00406-011-0211-9.CrossRefPubMedGoogle Scholar
  9. 9.
    Salmelainen P. Trends in the prescribing of stimulant medication for the treatment of attention deficit hyperactivity disorder in adults in NSW. NSW Public Health Bull. 2004;15(S-3):1–55.CrossRefGoogle Scholar
  10. 10.
    Prosser B, Lambert MC, Reid R. Psychostimulant prescription for ADHD in new South Wales: a longitudinal perspective. J Atten Disord. 2015;19(4):284–92.  https://doi.org/10.1177/1087054714553053.CrossRefPubMedGoogle Scholar
  11. 11.
    McGough JJ, Smalley SL, McCracken JT, Yang M, Del’Homme M, Lynn DE, et al. Psychiatric comorbidity in adult attention deficit hyperactivity disorder: findings from multiplex families. Am J Psychiatry. 2005;162(9):1621–7.  https://doi.org/10.1176/appi.ajp.162.9.1621.CrossRefPubMedGoogle Scholar
  12. 12.
    Bro SP, Kjaersgaard MI, Parner ET, Sorensen MJ, Olsen J, Bech BH, et al. Adverse pregnancy outcomes after exposure to methylphenidate or atomoxetine during pregnancy. Clin Epidemiol. 2015;7:139–47.  https://doi.org/10.2147/clep.s72906.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Haervig KB, Mortensen LH, Hansen AV, Strandberg-Larsen K. Use of ADHD medication during pregnancy from 1999 to 2010: a Danish register-based study. Pharmacoepidemiol Drug Saf. 2014;23(5):526–33.  https://doi.org/10.1002/pds.3600.CrossRefPubMedGoogle Scholar
  14. 14.
    Oei J, Abdel-Latif ME, Clark R, Craig F, Lui K. Short-term outcomes of mothers and infants exposed to antenatal amphetamines. Arch Dis Child Fetal Neonatal Ed. 2010;95(1):F36–41.  https://doi.org/10.1136/adc.2008.157305.CrossRefPubMedGoogle Scholar
  15. 15.
    NSW Ministry of Health. Criteria for the diagnosis and management of attention deficit hyperactivity disorder in adults (TG 190/4). NSW Ministry of Health Legal and Regulatory Services Branch Pharmaceutical Services 2015. http://www.health.nsw.gov.au/pharmaceutical/Documents/adhd-criteria-adult.pdf. Accessed 11 Jun 2016.
  16. 16.
    NSW Ministry of Health. NSW Perinatal Data Collection (PDC) Reporting and Submission Requirements from 1 January 2016. http://www0.health.nsw.gov.au/policies/pd/2015/pdf/PD2015_025.pdf. Accessed 22 Jan 2018.
  17. 17.
    NSW Ministry of Health. Perinatal Data Collection Data Dictionary August 2014. http://www.cherel.org.au/media/31703/pdc_data_dictionary_august_2014-a.docx. Accessed 22 Jan 2018.
  18. 18.
    Kelman CW, Bass AJ, Holman CD. Research use of linked health data—a best practice protocol. Aust N Z J Public Health. 2002;26(3):251–5.CrossRefPubMedGoogle Scholar
  19. 19.
    Hennessy S, Bilker WB, Berlin JA, Strom BL. Factors influencing the optimal control-to-case ratio in matched case-control studies. Am J Epidemiol. 1999;149(2):195–7.CrossRefPubMedGoogle Scholar
  20. 20.
    Taylor L, Pym M, Bajuk B, Sutton L, Travis S, Banks C. Part 8: validation study NSW midwives data collection 1998. N S W Public Health Bull Suppl Ser. 2000;11(1):97–9.  https://doi.org/10.1071/NB00S11.CrossRefGoogle Scholar
  21. 21.
    Pottegard A, Hallas J, Andersen JT, Lokkegaard EC, Dideriksen D, Aagaard L, et al. First-trimester exposure to methylphenidate: a population-based cohort study. J Clin Psychiatry. 2014;75(1):e88–93.  https://doi.org/10.4088/JCP.13m08708.CrossRefPubMedGoogle Scholar
  22. 22.
    Raisanen S, Kramer MR, Gissler M, Saari J, Heinonen S. Unemployment at municipality level is associated with an increased risk of small for gestational age births–a multilevel analysis of all singleton births during 2005-2010 in Finland. Int J Equity Health. 2014;13(1):95.  https://doi.org/10.1186/s12939-014-0095-1.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Modesto-Lowe V, Danforth JS, Neering C, Easton C. Can we prevent smoking in children with ADHD: a review of the literature. Conn Med. 2010;74(4):229–36.PubMedGoogle Scholar
  24. 24.
    Barkley RA, Fischer M, Smallish L, Fletcher K. Young adult outcome of hyperactive children: adaptive functioning in major life activities. J Am Acad Child Adolesc Psychiatry. 2006;45(2):192–202.  https://doi.org/10.1097/01.chi.0000189134.97436.e2.CrossRefPubMedGoogle Scholar
  25. 25.
    Weisler RH, Biederman J, Spencer TJ, Wilens TE, Weisler RH, Biederman J, et al. Long-term cardiovascular effects of mixed amphetamine salts extended release in adults with ADHD. CNS Spectrums. 2005;10(12 Suppl 20):35–43.CrossRefPubMedGoogle Scholar
  26. 26.
    Jones SC, Jones I. Pharmacological management of bipolar disorder in pregnancy. CNS Drugs. 2017.  https://doi.org/10.1007/s40263-017-0452-x.PubMedGoogle Scholar
  27. 27.
    Andrade SE, Raebel MA, Brown J, Lane K, Livingston J, Boudreau D, et al. Use of antidepressant medications during pregnancy: a multisite study. Am J Obstet Gynecol. 2008;198(2):194.e1–5.  https://doi.org/10.1016/j.ajog.2007.07.036.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Sydney Medical School NepeanThe University of SydneyPenrithAustralia
  2. 2.School of Public HealthThe University of SydneySydneyAustralia
  3. 3.School of Population and Global HealthThe University of Western AustraliaPerthAustralia
  4. 4.Charles Perkins Centre NepeanThe University of SydneyPenrithAustralia
  5. 5.Department of PaediatricsNepean HospitalPenrithAustralia

Personalised recommendations