Key Takeaways
Extended Takeaways
- Pregnant patients with maternal ADHD differed substantially from those without ADHD, including younger median age (23 vs 31 years), more primiparity (56.1% vs. 42.9%), greater concentration in the lowest neighborhood income quintile (33.1% vs 19.6%), and much higher psychiatric comorbidity (86.8% vs 42.9% for psychiatric history).
- The sharpest recent change occurred during the COVID-19 era, with maternal ADHD rising from 1.6% in 2019 to 2.5% in 2023; clinicians in perinatal settings may need to anticipate a faster-growing referral population than earlier trends suggested.
- Lisdexamfetamine accounted for much of the prescribing increase, rising from 5.7% to 19.9% in the year before pregnancy and from 2.6% to 10.0% during pregnancy, and it became the most prevalent ADHD medication in pregnancy by the end of the study period.
- Stimulant exposure was most common in the first trimester and increased across all trimesters, reaching 19.3% in T1 in 2023 for any ADHD; this timing matters clinically because early-pregnancy exposure is especially relevant when counseling about reproductive safety.
- Among patients with stimulant use in the preconception year, discontinuation clustered before conception and in T1 rather than later pregnancy: in 2023, 50.5% stopped before conception, 24.6% in T1, and 3.6% in T2, while 15.9% continued throughout pregnancy and 5.5% later reinitiated treatment.
- Findings were directionally robust when ADHD was defined more stringently as at least 2 recorded diagnoses, with slightly lower maternal ADHD prevalence but slightly higher proportions of medication use before and during pregnancy and similar time trends overall.
