title: Adverse pregnancy outcomes after exposure to methylphenidate or atomoxetine during pregnancy.
abstract: OBJECTIVE
  To determine if prenatal exposure to methylphenidate (MPH) or atomoxetine (ATX) increases the risk of adverse pregnancy outcomes in women with attention deficit/hyperactivity disorder (ADHD).
  
  
  METHODS
  This was a population-based cohort study of all pregnancies in Denmark from 1997 to 2008. Information on use of ADHD medication, ADHD diagnosis, and pregnancy outcomes was obtained from nationwide registers.
  
  
  RESULTS
  We identified 989,932 pregnancies, in which 186 (0.02%) women used MPH/ATX and 275 (0.03%) women had been diagnosed with ADHD but who did not take MPH/ATX. Our reference pregnancies had no exposure to MPH/ATX and no ADHD diagnosis. Exposure to MPH/ATX was associated with an increased risk of spontaneous abortion (SA; ie, death of an embryo or fetus in the first 22 weeks of gestation) (adjusted relative risk [aRR] 1.55, 95% confidence interval [CI] 1.03-2.36). The risk of SA was also increased in pregnancies where the mother had ADHD but did not use MPH/ATX (aRR 1.56, 95% CI 1.11-2.20). The aRR of Apgar scores <10 was increased among exposed women (aRR 2.06, 95% CI 1.11-3.82) but not among unexposed women with ADHD (aRR 0.99, 95% CI 0.48-2.05).
  
  
  CONCLUSIONS
  MPH/ATX was associated with a higher risk of SA, but our study indicated that it may at least partly be explained by confounding by indication. Treatment with MPH/ATX was however associated with low Apgar scores <10, an association not found among women with ADHD who did not use MPH/ATX.
authors: Research Unit and Section for General Practice, Department of Public Health, Aarhus University, Aarhus, Denmark.
authors: Søren Pauli
authors: SP
authors: Bro
authors: Section for Biostatistics, Department of Public Health, Aarhus University, Aarhus, Denmark.
authors: Maiken Ina Siegismund
authors: MI
authors: Kjaersgaard
authors: Section for Biostatistics, Department of Public Health, Aarhus University, Aarhus, Denmark.
authors: Erik Thorlund
authors: ET
authors: Parner
authors: Regional Center for Child and Adolescent Psychiatry, Aarhus University Hospital, Aarhus, Denmark.
authors: Merete Juul
authors: MJ
authors: Sørensen
authors: Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark.
authors: Jørn
authors: J
authors: Olsen
authors: Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark.
authors: Bodil Hammer
authors: BH
authors: Bech
authors: Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark ; Department of Clinical Medicine - Obstetrics and Gynecology, Aarhus University, Aarhus, Denmark.
authors: Lars Henning
authors: LH
authors: Pedersen
authors: Department of Clinical Pharmacology, Aarhus University Hospital, Aarhus, Denmark ; Department of Neurology, Aarhus University Hospital, Aarhus, Denmark.
authors: Jakob
authors: J
authors: Christensen
authors: Research Unit and Section for General Practice, Department of Public Health, Aarhus University, Aarhus, Denmark.
authors: Mogens
authors: M
authors: Vestergaard
keywords: ADHD; atomoxetine; attention deficit/hyperactivity disorder; methylphenidate; pregnancy outcomes
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