January 18, 2018
The number of reproductive-age women in the United States who receive prescription medications for attention-deficit/hyperactivity disorder (ADHD) jumped more than 300% from 2003 to 2015, according to data released today by the Centers for Disease Control and Prevention (CDC).
Given that half of US pregnancies are unintended, more research on the safety of ADHD medications in this population is needed to help women and their healthcare providers make evidence-based decisions about the risks and benefits of ADHD treatment options during pregnancy, they say.
The researchers report their findings in the January 18 issue of the Morbidity and Mortality Weekly Report.
Public Health Concern
Using the Truven Health MarketScan commercial database, the researchers examined outpatient pharmacy prescription drug claims for ADHD medications among female patients aged 15 to 44 years for the period 2003 to 2015. The analysis included 2.3 million to 6.8 million reproductive-age women per year. All of the women had private health insurance that covered prescription drugs.
The percentage of women who filled a prescription for an ADHD medication rose from 0.9% in 2003 to 4.0% in 2015 ? an increase of 344%, the researchers report.
ADHD prescriptions increased for all subgroups of female patients aged 15 years to 44 years (analyzed in 5-year increments), and in all geographic regions of the country. The largest increase in ADHD prescriptions occurred among women aged 25 to 29 years (700% increase), followed by women aged 30 to 34 (560% increase).
In 2015, the most commonly filled ADHD medications among reproductive-aged women were mixed amphetamine salts (Adderall, Shire), lisdexamfetamine (Vyvanse, Shire), and methylphenidate (multiple brands). The average number of prescriptions filled for any ADHD medication per year rose from an average of 5.5 in 2003 to 7.2 in 2015.
"The substantial increase in the percentage of reproductive-aged women filling ADHD medication prescriptions from 2003 to 2015, across age groups and US geographic regions, is of public health concern given the high percentage of unintended pregnancies and uncertainty concerning the safety of ADHD medication exposure before and during pregnancy," write Dr Anderson and colleagues.
"Although evidence is limited and findings are mixed," they add, "ADHD medication use during pregnancy might be linked to increased risk for poor pregnancy outcomes, including spontaneous abortion. The safety of ADHD medications with regard to risk for birth defects is largely unknown."
Recently, two large studies of pregnant women with ADHD suggested that stimulant medications taken during pregnancy are associated with a modestly increased risk for perinatal and placental abnormalities, as reported by Medscape Medical News. The authors of both studies, though, caution that those risks must be weighed against the risks associated with untreated ADHD.
"Early pregnancy is a critical time for the developing baby. We need to better understand the safest ways to treat ADHD before and during pregnancy," Coleen Boyle, PhD, director of the CDC's National Center on Birth Defects and Developmental Disabilities, said in a news release.
The study had no commercial funding. The authors have disclosed no relevant financial relationships.