Clinical Summary
Clinical Summary: Time Trends in Maternal Attention-Deficit/Hyperactivity Disorder and Medication Use in Pregnancy
Pregnant women with attention-deficit/hyperactivity disorder are becoming a larger part of perinatal practice, and many are weighing whether to continue stimulant treatment while facing limited pregnancy-specific safety data. This study quantifies how fast maternal ADHD and stimulant use in pregnancy are rising, which matters for counseling, care planning, and service capacity.
Design
We conducted a cross-sectional time series analysis using health administrative data covering the entire province of Ontario, Canada (population ∼15 million).
N
2,327,110 included pregnancies
Population
all obstetrical deliveries (live- or stillbirth >20 weeks gestation) in ICES’ MOMBABY database with an estimated start of pregnancy between April 1, 2002, and March 31, 2024
Duration
from 2002 to 2023
Key Findings
- Among 2,327,110 included pregnancies between 2002 and 2023, 28,875 (1.2%) met criteria for maternal ADHD within 10 years prior to childbirth and 8,815 (0.4%) within 3 years prior to childbirth.
- The proportion of pregnancies with maternal ADHD increased from 0.5% in 2002 to 2.5% in 2023 for any ADHD, and from 0.1% to 1.3% for current ADHD, with the highest increases from 1.8% in 2021 to 2.5% in 2023.
- Between 2014 and 2023, among pregnancies with any ADHD, the prevalence of any filled stimulant prescription increased from 21.8% to 39.8% in the year prior to pregnancy and from 10.1% to 20.9% during pregnancy.
- Lisdexamfetamine showed the largest increase over time, rising from 5.7% to 19.9% preconception and from 2.6% to 10.0% in pregnancy; over the same period, methylphenidate increased from 13.4% to 16.6% preconception and from 5.6% to 7.3% in pregnancy.
- In 2023, among those with stimulant use in the preconception year, 50.5% discontinued before conception, 24.6% in T1, 3.6% in T2, 15.9% continued stimulant treatment throughout the pregnancy, and 5.5% reinitiated treatment later in pregnancy.
Clinical Bottom Line
Maternal attention-deficit/hyperactivity disorder now affects 1 in 40 pregnancies in this Ontario cohort, and stimulant use during pregnancy has doubled over the last decade. Perinatal clinicians should expect more patients needing individualized decisions about stimulant continuation, especially as lisdexamfetamine use rises despite limited pregnancy safety data.
Practice Implications
- Ask about attention-deficit/hyperactivity disorder and current stimulant treatment early in pregnancy, because stimulant use was most common in T1 and reached 19.3% in 2023 for any ADHD.
- Plan counseling before conception when possible: in 2023, 50.5% discontinued before conception and 24.6% in T1, indicating that treatment decisions cluster around the start of pregnancy.
- Pay particular attention to lisdexamfetamine exposure history, as use increased from 5.7% to 19.9% preconception and from 2.6% to 10.0% in pregnancy and became the most prevalent ADHD medication in pregnancy by the end of the period.
- Expect high psychiatric complexity in this population, since the pregnant population with maternal ADHD had a higher proportion of psychiatric history than those without ADHD (86.8% vs 42.9%), which should inform monitoring and support needs during the perinatal period.
