Maternal and Neonatal Outcomes Associated with the use of Dexamphetamine or Methylphenidate in Pregnancy: A Retrospective Cohort Study

Objective: The use of attention-deficit/hyperactivity disorder (ADHD) medications, dexamphetamine (DEX) and methylphenidate (MPH), during pregnancy is increasing. While previous studies have investigated ADHD medication usage compared to no use, it remains unclear if the risks differ between these medications, as no studies have compared their safety in pregnancy. This study examined maternal and neonatal outcomes (health risk to pregnant person and infant) associated with DEX and MPH use during pregnancy. Methods: This retrospective cohort study used whole-population dispensing and perinatal records to identify mother-infant dyads exposed to DEX ( n = 852) or MPH ( n = 65) in Western Australia between 2003 and 2018. Maternal and neonatal outcomes were compared between the groups using generalised linear models. Results: Maternal outcomes, including preeclampsia, c-sections, and post-partum haemorrhage, were not different between people dispensed MPH or DEX during pregnancy. Neonates prenatally exposed to DEX compared to MPH had a higher length-for-gestational-age (coeff:1.59, 95% CI: 0.35, 2.84). However, there were no differences between the two groups in terms of other neonatal outcomes, including gestational age, birth weights and rates of pre-term births. Conclusion: Maternal and neonatal health outcomes were comparable between people treated with DEX or MPH during pregnancy. Further large-scale studies are needed to confirm findings.