School of Business and Social Sciences, NCRR - National Centre for Register-based Research, Aarhus University, Fuglesangs Allé 26, Building R, 8210, Aarhus V, Denmark.
CIRRAU - Centre for Integrated Register-based Research, Aarhus University, Aarhus, Denmark.
CNS Drugs. 2024 Apr;38(4):303-314. doi: 10.1007/s40263-024-01076-1. Epub 2024 Mar 15.
An increasing number of women of reproductive age are treated with attention-deficit hyperactivity disorder (ADHD) medication; however, patterns of ADHD medication use for women in the perinatal period have not been well described.
This study aimed to describe ADHD medication use patterns from 1 year before pregnancy to 1 year after delivery, and to describe sociodemographic characteristics and clinical features by medication trajectories.
The population-based cohort study included pregnancies in Denmark between 1997 and 2020, from the Medical Birth Register, by women who filled at least one prescription for ADHD medication from 12 months before pregnancy until 12 months after delivery. We applied group-based trajectory modeling to classify women into subgroups based on the identification of heterogeneous ADHD medication treatment patterns, and described the characteristics associated with these groups.
Overall, we included 4717 pregnancies leading to liveborn singletons by 4052 mothers with a mean (standard deviation) age of 27.5 (5.6) years. We identified four treatment trajectories across pregnancy and the postpartum period: continuers (23.3%), discontinuers (41.8%), interrupters who ceased filling prescriptions during pregnancy but resumed postpartum (17.2%), and postpartum initiators (17.7%). Continuers were older at the time of conception, gave birth in more recent years, were more likely to smoke during pregnancy, and used other psychotropic medications during pregnancy. A large proportion of continuers used methylphenidate (89.1%) compared with the other groups (75.9-84.1%) and had switched ADHD medication type during the whole period (16.4% vs. 7.4-14.8%).
We found that approximately 60% of women discontinued or interrupted their ADHD medication around pregnancy, and those who continued differed in sociodemographic and clinical factors that may reflect more severe ADHD.
越来越多处于生育年龄的女性接受了注意力缺陷多动障碍（ADHD）药物治疗；然而，围产期女性使用 ADHD 药物的模式尚未得到很好的描述。
本研究旨在描述从怀孕前 1 年到产后 1 年的 ADHD 药物使用模式，并按药物轨迹描述社会人口统计学特征和临床特征。
这项基于人群的队列研究包括 1997 年至 2020 年期间丹麦的妊娠，来自于医疗出生登记处，由至少在怀孕前 12 个月至产后 12 个月期间开具过 ADHD 药物处方的女性组成。我们应用基于群组的轨迹建模方法，根据 ADHD 药物治疗模式的异质性将女性分为亚组，并描述与这些亚组相关的特征。
总体而言，我们纳入了 4717 例由 4052 位母亲所生育的活产单胎妊娠，母亲的平均（标准差）年龄为 27.5（5.6）岁。我们在整个妊娠和产后期间确定了四种治疗轨迹：持续用药者（23.3%）、停药者（41.8%）、中断用药者（怀孕期间停止配药但产后恢复用药者，17.2%）和产后起始用药者（17.7%）。持续用药者在受孕时年龄较大，生育年份更新，怀孕期间更有可能吸烟，并且在怀孕期间使用了其他精神药物。与其他组（75.9%-84.1%）相比，很大一部分持续用药者（89.1%）使用了哌醋甲酯，并且在整个时期都更换了 ADHD 药物类型（16.4%比 7.4%-14.8%）。
我们发现，大约 60%的女性在怀孕期间停止或中断了 ADHD 药物治疗，而继续用药的女性在社会人口统计学和临床特征上有所不同，这可能反映了更严重的 ADHD。
