Question of the Day – Wednesday January 31, 2018

Question- What are the placental complications, if any, associated with psychostimulant use in pregnancy?

Answer-One recent study reported on more than 3000 pregnancies that involved exposed to amphetamine-dextroamphetamine, methylphenidate or atomoxetine as follows: “Among unexposed women, the risks of the outcomes were 3.7% for preeclampsia, 1.4% for placental abruption, 2.9% for small for gestational age, and 11.2% for preterm birth. The adjusted risk ratio for stimulant use was 1.29 for preeclampsia (95% CI 1.11–1.49), 1.13 for placental abruption (0.88–1.44), 0.91 for small for gestational age (0.77–1.07), and 1.06 for preterm birth (0.97–1.16). Compared with discontinuation (n=53,527), the adjusted risk ratio for continuation of stimulant use in the latter half of pregnancy (n=51,319) was 1.26 for preeclampsia (0.94–1.67), 1.08 for placental abruption (0.67–1.74), 1.37 for small for gestational age (0.97–1.93), and 1.30 for preterm birth (1.10–1.55). Atomoxetine was not associated with the outcomes studied.” These authors concluded “Psychostimulant use during pregnancy was associated with a small increased relative risk of preeclampsia and preterm birth. The absolute increases in risks are small and, thus, women with significant ADHD should not be counseled to suspend their ADHD treatment based on these findings.” (Cohen JM et al. Placental complications associated with psychostimulant use in pregnancy. 2017 Obstet Gynecol 130(6):1192-1201)