(P-601) Patterns and Predictors of Stimulant Use During Pregnancy

Background: Data around the safety of in utero exposure to stimulant medications for the unborn child are conflicting. Despite this uncertainty, women with Attention Deficit Hyperactivity Disorder (ADHD) must decide whether to continue their stimulant treatment during pregnancy.

Objectives: To describe and compare patterns of stimulant use during pregnancy.

Methods: We used MarketScan claims data from 2013 to 2018 and a retrospective cohort design to assess use of methylphenidate and amphetamine containing products during pregnancy episodes. Each pregnancy episode consisted of 5 observation windows: pre-conception (270-1 day prior to conception), the three trimesters of pregnancy, and a 90-day post-pregnancy period. Pregnancy episodes were categorized to represent stimulant discontinuation prior to conception, during Trimester 1, or later stages of pregnancy. Clinical and demographic characteristics were compared between pregnant women who were stimulant users vs non-users. Associations were tested for significance using chi‐square tests (categorical variables) and independent t‐tests (continuous variables). Women were included in this analysis if they had a medical claim for a birth delivery and were insured for the entire observation window. Pregnancies terminated prior to birth were excluded.

Results: Among 612,001 pregnancy episodes, we identified stimulant exposure in the pre-conception window of 15,413 pregnancies (2.5%). Of these, stimulant use was stopped prior to conception in 6,416 (42%) pregnancies, stopped during trimester 1 in 5,977 (39%), and continued into trimesters 2 or 3 in 3,020 (19%). Compared to pregnancy episodes without stimulant exposure, pregnancies with exposure were in women who were younger (29.4 vs 30.7 years old) and had a higher frequency of tobacco use (6.7% vs 2.8%), alcohol use (0.9% vs 0.2%), hypertension (3.4% vs 2.9%), and chronic lung disease (5.9% vs 3.7%), all risk factors for adverse pregnancy outcomes. Rates of psychiatric comorbidities were also higher among stimulant users than non-users: ADHD (66.8% vs 0.4%), depression (10.6% vs 2.7%), anxiety (13.2% vs 3.5%), and bipolar disorder (1.1% vs 0.2%). All differences were statistically significant (p < 0.05).

Conclusions: We found that there is considerable heterogeneity in a woman’s decision to continue her stimulant during pregnancy. Furthermore, the presence of coexisting risk factors may lead to similar outcomes despite discontinuation of the stimulant. Treatment discontinuation can have important implications for work productivity and mental health. Further research is needed to determine maternal and infant outcomes related to stimulant continuation and discontinuation during pregnancy.