Faculty of Pharmacy, University of Montreal, Montreal, Quebec, Canada.
Research Center, CHU Sainte-Justine, Montreal, Quebec, Canada.
Pharmacol Res Perspect. 2021 May;9(3):e00781. doi: 10.1002/prp2.781.
The use of attention deficit/hyperactivity disorder (ADHD) medications has grown over the past decade among pregnant women, but these treatments are not without risk. Updated prevalence of ADHD medication use and whether prescribed dosages follow guidelines are needed. The aim of this study is to describe the prevalence of ADHD medication use among pregnant women-dosages and switches-and identify determinants of ADHD medication use.
A population-based longitudinal cohort study within the Quebec Pregnancy/Children Cohort (QPC). Women aged 15-45 years old covered by the RAMQ prescription drug plan for at least 12 months before and during pregnancy from 1998 to 2015. ADHD medication exposure was assessed before and during pregnancy. We estimated odds ratios (ORs) for determinants of ADHD medication use during pregnancy with generalized estimating equations.
Among 428,505 included pregnant women, 1,130 (0.26%) used ADHD medication. A 14-fold increase in the prevalence of ADHD medication use in pregnant women was observed, from 1998 (0.08%) to 2015 (1.2%). Methylphenidate was the most prevalent medication at 70.1%. ADHD medication fillings were at optimal dosage 91.8% of the time based on guidelines and 18.1% of women switched to another ADHD medication class during gestation. Main determinants of ADHD medication use during pregnancy were psychiatric disorders (aOR 2.19; 95% confidence interval [CI] 1.57, 2.96), mood and anxiety disorders (aOR 1.74; 95% CI 1.32, 2.24), and calendar year.
The number of pregnancies exposed to ADHD medications has increased similarly to the increase reported in other countries between 1998 and 2015. In addition to the current literature, the use of ADHD medications during pregnancy is consistent with Canadian guidelines recommendations on dosage.
在过去十年中，孕妇使用注意力缺陷/多动障碍（ADHD）药物的情况有所增加，但这些治疗方法并非没有风险。需要更新 ADHD 药物使用的流行率以及处方剂量是否符合指南。本研究的目的是描述孕妇中 ADHD 药物使用的流行率——剂量和转换——并确定 ADHD 药物使用的决定因素。
在魁北克妊娠/儿童队列（QPC）中进行了一项基于人群的纵向队列研究。研究对象为 1998 年至 2015 年期间至少在怀孕前和怀孕期间 12 个月内使用 RAMQ 处方药计划的 15-45 岁女性。在怀孕前和怀孕期间评估 ADHD 药物暴露情况。我们使用广义估计方程估计了怀孕期间 ADHD 药物使用的决定因素的优势比（OR）。
在纳入的 428505 名孕妇中，有 1130 名（0.26%）使用了 ADHD 药物。孕妇中 ADHD 药物使用的流行率增加了 14 倍，从 1998 年（0.08%）到 2015 年（1.2%）。哌醋甲酯是最常见的药物，占 70.1%。根据指南，ADHD 药物的填充剂量有 91.8%是最佳剂量，18.1%的女性在妊娠期间转换为另一种 ADHD 药物类别。怀孕期间使用 ADHD 药物的主要决定因素是精神障碍（OR 2.19；95%置信区间[CI]1.57,2.96）、情绪和焦虑障碍（OR 1.74；95%CI 1.32,2.24）和日历年份。
自 1998 年至 2015 年期间，接触 ADHD 药物的孕妇数量增加与其他国家的报告增加相似。除了当前的文献外，怀孕期间使用 ADHD 药物也符合加拿大关于剂量的指南建议。
