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The Journal of Clinical Psychiatry

Original Research Focus on Women’s Mental Health August 26, 2026

Obstetric Risk Associated With Stimulant Versus Nonstimulant Treatment During Pregnancy

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J Clin Psychiatry 2026;87(3):26m16372

Abstract

Objective: To evaluate and compare the obstetric risks associated with stimulant and nonstimulant medication use during pregnancy.

Methods: This retrospective cohort study used TriNetX electronic health records from 894,986 pregnancies recorded between 2010 and 2023. Women aged 18–45 years were grouped by attention-deficit/hyperactivity disorder (ADHD) medication exposure during pregnancy: stimulant (n=3,465), nonstimulant (n=575), or no ADHD medication (n=890,946). Propensity score–based inverse probability of treatment weighting balanced demographic, substance use, medical, and mental health factors, including ADHD. Weighted logistic regression compared adverse pregnancy outcomes across groups.

Results: Stimulant and nonstimulant use during pregnancy were both associated with increased risk for several obstetric complications compared to no medication, with increased-risk odds ratios ranging from 1.21 to 1.85 for stimulants and 1.12 to 5.70 for nonstimulants. Compared with nonstimulants, stimulants were associated with higher odds of placenta previa and large for gestational age but lower odds of gestational diabetes, placental abruption, intrauterine growth restriction, and preterm delivery.

Conclusion: Stimulant and nonstimulant use during pregnancy were associated with increased obstetric risk. Given the observational electronic health record design, lack of an ADHD-unmedicated comparison group, and lack of adjustment for concomitant medication exposures, findings should be interpreted as potential safety signals rather than definitive causal estimates. Findings support individualized risk-benefit assessment and further research on ADHD treatment during pregnancy.

J Clin Psychiatry 2026;87(3):26m16372

Author affiliations are listed at the end of this article.

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  1. Bang Madsen K, Bliddal M, Skoglund CB, et al. Attention-deficit hyperactivity disorder (ADHD) medication use trajectories among women in the perinatal period. CNS Drugs. 2024;38(4):303–314. PubMed CrossRef
  2. Baker AS, Wales NO, Gaccione P, et al. The course of ADHD during pregnancy. J Atten Disord. 2022;26(2):143–148. PubMed CrossRef
  3. Tai S, Patel S, Downes K, et al. Maternal and offspring outcomes associated with prescribed ADHD medication in pregnancy: a systematic review. Arch Womens Ment Health. 2025;28(6):1425–1446. PubMed CrossRef
  4. Russell DJ, Wyrwoll CS, Preen DB, et al. Investigating maternal and neonatal health outcomes associated with continuing or ceasing dexamphetamine treatment for women with attention-deficit hyperactivity disorder during pregnancy: a retrospective cohort study. Arch Womens Ment Health. 2024;27(5):785–794. PubMed CrossRef
  5. Li L, Sujan AC, Butwicka A, et al. Associations of prescribed ADHD medication in pregnancy with pregnancy-related and offspring outcomes: a systematic review. CNS Drugs. 2020;34(7):731–747. PubMed CrossRef
  6. Baker AS, Freeman MP. Management of attention deficit hyperactivity disorder during pregnancy. Obstet Gynecol Clin N Am. 2018;45(3):495–509. PubMed CrossRef
  7. Scoten O, Tabi K, Paquette V, et al. Attention-deficit/hyperactivity disorder in pregnancy and the postpartum period. Am J Obstet Gynecol. 2024;231(1):19–35. PubMed CrossRef
  8. Smid MC, Metz TD, Gordon AJ. Stimulant use in pregnancy. Clin Obstet Gynecol. 2019;62(1):168–184. PubMed
  9. Russell DJ, Quintrell E, Wyrwoll CS, et al. Prevalence of the prescribing of attention-deficit hyperactivity disorder medication during pregnancy: a systematic review. J Psychoact Drugs. 2025:1–11. PubMed CrossRef
  10. Nitchske A, Salmanpour A, Kaur P, et al. Prevalence trends and patterns of perinatal ADHD stimulant medication use in British Columbia, Canada. Pharmacoepidemiol Drug Saf. 2025;34(4):1–10. PubMed CrossRef
  11. Lemelin M, Boukhris T, Zhao JP, et al. Prevalence and determinants of attention deficit/hyperactivity disorder (ADHD) medication use during pregnancy: results from the Quebec pregnancy/children cohort. Pharmacol Res Perspect. 2021;9(3):1–11. PubMed CrossRef
  12. Cohen JM, Srinivas C, Furu K, et al. Prevalence trends and individual patterns of ADHD medication use in pregnancy in Norway and Sweden, 2010–2019. Eur J Clin Pharmacol. 2023;79(1):173–180. PubMed CrossRef
  13. Bro SP, Kjaersgaard MIS, Parner ET, et al. Adverse pregnancy outcomes after exposure to methylphenidate or atomoxetine during pregnancy. Clin Epidemiol. 2015;7:139–147. PubMed CrossRef
  14. Cohen JM, Hernández-Díaz S, Bateman BT, et al. Placental complications associated with psychostimulant use in pregnancy. Obstetrics Gynecol. 2017;130(6):1192–1201. PubMed CrossRef
  15. Sit A, Bruno C, Araki M, et al. Attention-deficit/hyperactivity disorder medication use and cardiometabolic conditions in pregnancy: a population-based cohort study. 2024. doi:10.22541/au.172742419.94824081/v1 CrossRef
  16. Camacho X, Zoega H, Gomes T, et al. The association between psychostimulant use in pregnancy and adverse maternal and neonatal outcomes: results from a distributed analysis in two similar jurisdictions. Int J Epidemiol. 2023;52(1):190–202. PubMed CrossRef
  17. Srinivas C, Karlstad Ø, Stigum H, et al. Attention-deficit/hyperactivity disorder medication use in pregnancy and risk of preterm birth: a population-based cohort study. Paediatr Perinat Epid. 2025;40(2):ppe.70031–290. PubMed CrossRef
  18. Srinivas C, Karlstad Ø, Stigum H, et al. Attention-deficit hyperactivity disorder medication use in pregnancy and risk of miscarriage. Br J Psychiatry. 2025:1–7. PubMed CrossRef
  19. Di Giacomo E, Confalonieri V, Tofani F, et al. Methylphenidate and atomoxetine in pregnancy and possible adverse fetal outcomes: a systematic review and meta-analysis. JAMA Netw Open. 2024;7(11):e2443648. PubMed CrossRef
  20. Bröms G, Hernandez-Diaz S, Huybrechts KF, et al. Atomoxetine in early pregnancy and the prevalence of major congenital malformations: a multinational study. J Clin Psychiatr. 2023;84(1):22m14430. PubMed CrossRef
  21. Cleary-Goldman J, Malone FD, Vidaver J, et al. Impact of maternal age on obstetric outcome. Obstetrics Gynecol. 2005;105(5 Part 1):983–990. https://lww.com/greenjournal/fulltext/2005/05000/impact_of_maternal_age_on_obstetric_outcome.11.aspx PubMedCrossRef
  22. Kenny LC, Lavender T, McNamee R, et al. Advanced maternal age and adverse pregnancy outcome: evidence from a large contemporary cohort. PLoS ONE. 2013;8(2):1–9. PubMed CrossRef
  23. Grobman WA, Parker CB, Willinger M, et al. Racial disparities in adverse pregnancy outcomes and psychosocial stress. Obstetrics Gynecol. 2018;131(2):328–335. PubMed CrossRef
  24. Nigg JT. Attention-deficit/hyperactivity disorder and adverse health outcomes in adults. Clin Psychol Rev. 2013;33(2):215–228. PubMed CrossRef
  25. Pentecost R, Latendresse G, Smid M. Scoping review of the associations between perinatal substance use and perinatal depression and anxiety. JOGNN - J Obstetric, Gynecol Neonatal Nurs. 2021;50(4):382–391. PubMed CrossRef
  26. Montagnoli C, Zanconato G, Cinelli G, et al. Maternal mental health and reproductive outcomes: a scoping review of the current literature. Archives Gynecol Obstetrics. 2020;302(4):801–819. PubMed CrossRef
  27. Heinze G, Jüni P. An overview of the objectives of and the approaches to propensity score analyses. Eur Heart J. 2011;32(14):1704–1708. PubMed CrossRef
  28. Robins JM, Hernán MÁ, Brumback B. Marginal structural models and causal inference in epidemiology. Epidemiology. 2000;11(5):550–560. PubMed CrossRef
  29. Topaloglu U, Palchuk MB. Using a federated network of real-world data to optimize clinical trials operations. JCO Clin Cancer Inf. 2018;2(2):1–10. PubMed CrossRef
  30. Benchimol EI, Smeeth L, Guttmann A, et al. The REporting of studies Conducted using Observational Routinely-collected health Data (RECORD) Statement. PLoS Med. 2015;12(10):1–22. PubMed CrossRef
  31. Canelón SP, Burris HH, Levine LD, et al. Development and evaluation of MADDIE: Method to Acquire Delivery Date Information from Electronic health records. Int J Med Inf. 2021;145:104339. PubMed CrossRef
  32. Stout MJ, Van De Ven CJM, Parekh VI, et al. Use of electronic medical records to estimate changes in pregnancy and birth rates during the COVID-19 pandemic. JAMA Netw Open. 2021;4(6):1–10. PubMed CrossRef
  33. Chen H, Cohen P, Chen S. How big is a big odds ratio? Interpreting the magnitudes of odds ratios in epidemiological studies. Commun Stat Simulat Comput. 2010;39(4):860–864. CrossRef
  34. VanderWeele TJ. Principles of confounder selection. Eur J Epidemiol. 2019;34(3):211–219. PubMed CrossRef
  35. Schisterman EF, Cole SR, Platt RW. Overadjustment bias and unnecessary adjustment in epidemiologic studies. Epidemiology. 2009;20(4):488–495. https://lww.com/epidem/fulltext/2009/07000/overadjustment_bias_and_unnecessary_adjustment_in.4.aspx PubMedCrossRef
  36. Babinski DE, Libsack EJ. Adult diagnosis of ADHD in women: a mixed methods investigation. J Atten Disord. 2024;29(3):207–219. PubMed CrossRef

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