Review research on Dex

Dexamphetamine Use During Pregnancy: What the Research Shows

https://pubmed.ncbi.nlm.nih.gov/38424254/

Full Citation: Russell DJ, Wyrwoll CS, Preen DB, Kelty E. 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. Archives of Women's Mental Health. 2024;27(5):785-794. doi:10.1007/s00737-024-01450-4

Study at a Glance: This Australian population-based study examined 1,688 women with ADHD from Western Australia who gave birth between 2003-2018, comparing three groups: those who continued dexamphetamine (DEX) throughout pregnancy (n=547), those who stopped during pregnancy (n=297), and those who stopped before becoming pregnant (n=844).

Key Findings

The counterintuitive finding: Women who ceased DEX treatment during pregnancy had a 2.2-fold increased risk of threatened abortion (vaginal bleeding prior to 20 weeks gestation) compared to women who continued DEX treatment. nih This was statistically significant (OR: 2.28; 95% CI: 1.00-5.15; p=0.049).

What this might mean: This finding is particularly noteworthy, as it may be associated with the DEX withdrawal process. Although, it could also be explained that women who experienced a threatened abortion were more likely to cease their medication after the event. nih

The reassuring finding: Continuing dexamphetamine throughout pregnancy was not associated with an increase in adverse neonatal and maternal health outcomes compared to ceasing. nih

The "best case" scenario: Women who stopped DEX before becoming pregnant showed some benefits compared to those who continued throughout, including lower risks of:

• Preeclampsia (42% lower)
• Hypertension (68% lower)
• Postpartum hemorrhage (43% lower)
• Neonatal special care unit admission (84% lower)
• Fetal distress (27% lower)

Important Limitations

The study utilised routinely-collected administrative data, of which some information is not collected and thus could not be examined or controlled for. This included information on the exposure (e.g. actual medication use, medication adherence, and timing of medication cessation in relation to outcome ascertainment), outcomes of interest (e.g. pregnancy loss prior to 20 weeks), and confounders (e.g. severity of ADHD, and alcohol consumption during pregnancy). nih

The researchers couldn't determine whether stopping caused bleeding or whether bleeding prompted women to stop their medication—a classic "chicken or egg" problem.

Clinical Takeaway

This emphasises the importance of tailoring treatment plans for each woman, as they do have diverse range of personal experiences, expectations, and levels of risk. nih

In plain language for your audience:

• If you're already pregnant and on dexamphetamine, abruptly stopping may not be the safest choice and could potentially carry its own risks
• The "ideal" scenario appears to be stopping medication before conception if possible
• But if that ship has sailed, continuing may actually be safer than stopping mid-pregnancy
• This is a conversation to have with your prescriber—not a decision to make alone