A recent meta-analysis finds no significant increase in fetal risk from attention-deficit/hyperactivity disorder medications methylphenidate and atomoxetine.

The systematic review and meta-analysis, including 10 studies with a combined sample of over 16.6 million pregnancies, evaluated the safety of methylphenidate and atomoxetine for attention-deficit/hyperactivity disorder (ADHD) treatment during pregnancy. The analysis examined whether these medications increase the risk of congenital anomalies or miscarriage among offspring.

Published in JAMA Network Open, the review's findings indicated no statistically significant association between in utero exposure to methylphenidate or atomoxetine and increased risks of congenital anomalies or miscarriages. The odds ratio (OR) for congenital anomalies in pregnancies exposed to ADHD medications versus unexposed pregnancies was 1.14 (95% confidence interval [CI], 0.83-1.55; P = .41; I² = 8%), and for miscarriage, the OR was 1.01 (95% CI, 0.70-1.47; P = .96; I² = 0%). In comparison to the general population, the OR for congenital anomalies was 1.19 (95% CI, 0.93-1.53; P = .16; I² = 74%), while for miscarriages, it was 1.05 (95% CI, 0.81-1.37; P = .70; I² = 0%).

These findings suggest that methylphenidate and atomoxetine may be cautiously continued as first-line treatments for ADHD in pregnancy, accompanied by second-level fetal monitoring. The findings support the need for additional studies to substantiate these results and further guide clinical decision-making in this population.

The review suggests that ADHD treatment during pregnancy may carry no statistically significant increase in risk for fetal outcomes. Nevertheless, further research is needed to ensure evidence-based recommendations that support maternal and fetal health.

Full disclosures can be found in the published review.