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Placental Complications Associated With Psychostimulant Use in Pregnancy.

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eMediNexus    11 November 2017

A new study published in Obstetrics and Gynecology evaluated whether psychostimulants used to treat attention deficit hyperactivity disorder ADHD are associated with risk of adverse placental associated pregnancy outcomes including preeclampsia placental abruption growth restriction and preterm birth. This population based cohort study examined a cohort of pregnant women and their live born neonates enrolled in Medicaid from 2000 to 2010. Pregnancies exposed to amphetamine dextroamphetamine n 3 331 methylphenidate n 1 515 and atomoxetine n 453 monotherapy in early pregnancy were compared to 1 461 493 unexposed pregnancies. The results showed that among unexposed women the risks of the outcomes were 3.7 for preeclampsia 1.4 for placental abruption 2.9 for small for gestational age and 11.2 for preterm birth. The adjusted risk ratio for stimulant use was 1.29 for preeclampsia 1.13 for placental abruption 0.91 for small for gestational age and 1.06 for preterm birth. In comparison with discontinuation the adjusted risk ratio for continuation of stimulant use in the latter half of pregnancy was 1.26 for preeclampsia 1.08 for placental abruption 1.37 for small for gestational age and 1.30 for preterm birth. On the other hand atomoxetine was not associated with the outcomes studied. Hence it was inferred that psychostimulant use during pregnancy was associated with a small increased relative risk of preeclampsia and preterm birth. It was stated that the absolute increases in risks are small and thus women with significant ADHD should not be advised to suspend their ADHD treatment.

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