Investigating maternal and neonatal health outcomes associated with continuing or ceasing dexamphetamine treatment for women with attention-deficit hyperactivity disorder during pregnancy: a retrospective cohort study

IF 3.2 3区 医学 Q2 PSYCHIATRY Archives of Women's Mental Health Pub Date : 2024-03-01 DOI:10.1007/s00737-024-01450-4
Danielle J. Russell, Caitlin S. Wyrwoll, David B. Preen, Erin Kelty
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Abstract

Purpose

Attention-deficit hyperactivity disorder (ADHD) is becoming more commonly diagnosed in women, consequently, more women of reproductive age are taking ADHD medication, such as dexamphetamine. However, the safety associated with continuing or ceasing dexamphetamine during pregnancy is unclear. This study investigates outcomes associated with the continuation of dexamphetamine during pregnancy compared to those who ceased or were unexposed.

Methods

A population-based retrospective cohort of women from Western Australia who had been dispensed dexamphetamine during pregnancy and gave birth between 2003 and 2018. Women had either continued to take dexamphetamine throughout pregnancy (continuers, n = 547) or ceased dexamphetamine before the end of the second trimester (ceasers, n = 297). Additionally, a matched (1:1) comparison group of women who were dispensed an ADHD medication prior to pregnancy but not during pregnancy (unexposed) was included in the study (n = 844). Multivariable generalised linear models were used to compare maternal and neonatal health outcomes.

Results

Compared to continuers, ceasers had greater odds of threatened abortion (OR: 2.28; 95%CI: 1.00, 5.15; p = 0.049). The unexposed had some benefits compared to the continuers, which included lower risk of preeclampsia (OR: 0.58; 95%CI: 0.35, 0.97; p = 0.037), hypertension (OR: 0.32; 95%CI: 0.11, 0.93; p = 0.036), postpartum haemorrhage (OR: 0.57; 95%CI: 0.41, 0.80; p = 0.001), neonatal special care unit admittance (OR: 0.16; 95%CI: 0.12, 0.20; p < 0.001) and fetal distress (OR: 0.73; 95%CI: 0.54, 0.99; p = 0.042).

Conclusion

Continuing dexamphetamine throughout pregnancy was not associated with an increase in adverse neonatal and maternal health outcomes compared to ceasing. Ceasing dexamphetamine during pregnancy was associated with increased odds of threatened abortion compared with continuing dexamphetamine. However, this is something that requires further investigation due to the small sample size, difficulties examining timing, and the inability to examine spontaneous abortions. The unexposed showed some benefits compared to the continuers, suggesting that where possible the cessation of dexamphetamine prior to pregnancy may be advisable.

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调查妊娠期注意力缺陷多动障碍妇女继续或停止地塞米松治疗对孕产妇和新生儿健康的影响:一项回顾性队列研究。
目的:越来越多的女性被诊断患有注意力缺陷多动障碍(ADHD),因此,越来越多的育龄女性开始服用ADHD药物,如右旋苯丙胺。然而,怀孕期间继续或停止服用地塞米松的安全性尚不清楚。本研究调查了与停止使用或未使用地塞米松的女性相比,孕期继续使用地塞米松的相关结果:以人群为基础,对西澳大利亚州 2003 年至 2018 年期间在怀孕期间获得过右旋苯丙胺配药并分娩的妇女进行回顾性队列研究。妇女要么在整个孕期继续服用地塞米松(继续服用者,人数=547),要么在第二个孕期结束前停止服用地塞米松(停止服用者,人数=297)。此外,该研究还包括一个匹配(1:1)的对比组,即在怀孕前获得过注意力缺失多动症药物治疗,但在怀孕期间未获得过这种药物治疗的妇女(未服用者)(n = 844)。研究采用多变量广义线性模型来比较孕产妇和新生儿的健康结果:与继续妊娠者相比,终止妊娠者发生威胁流产的几率更高(OR:2.28;95%CI:1.00,5.15;P = 0.049)。与持续者相比,未暴露者有一些益处,包括先兆子痫风险较低(OR:0.58;95%CI:0.35,0.97;P = 0.037)、高血压(OR:0.32;95%CI:0.11,0.93;P = 0.036)、产后出血(OR:0.57;95%CI:0.41,0.80;P = 0.001)、新生儿特别护理病房入院(OR:0.16;95%CI:0.12,0.20;P 结论:与停止使用相比,在整个孕期继续使用右旋苯丙胺与新生儿和孕产妇不良健康结果的增加无关。与继续服用地塞米松相比,在妊娠期间停止服用地塞米松会增加受威胁流产的几率。不过,由于样本量较小,很难对时间进行检查,也无法对自然流产进行检查,因此这一点还需要进一步研究。与继续服用者相比,未接触者显示出一些益处,这表明在可能的情况下,在怀孕前停止服用地塞米松可能是可取的。
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来源期刊
Archives of Women's Mental Health
Archives of Women's Mental Health 医学-精神病学
CiteScore
8.00
自引率
4.40%
发文量
83
审稿时长
6-12 weeks
期刊介绍: Archives of Women’s Mental Health is the official journal of the International Association for Women''s Mental Health, Marcé Society and the North American Society for Psychosocial Obstetrics and Gynecology (NASPOG). The exchange of knowledge between psychiatrists and obstetrician-gynecologists is one of the major aims of the journal. Its international scope includes psychodynamics, social and biological aspects of all psychiatric and psychosomatic disorders in women. The editors especially welcome interdisciplinary studies, focussing on the interface between psychiatry, psychosomatics, obstetrics and gynecology. Archives of Women’s Mental Health publishes rigorously reviewed research papers, short communications, case reports, review articles, invited editorials, historical perspectives, book reviews, letters to the editor, as well as conference abstracts. Only contributions written in English will be accepted. The journal assists clinicians, teachers and researchers to incorporate knowledge of all aspects of women’s mental health into current and future clinical care and research.
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