TOPLINE:

Among individuals with attention-deficit/hyperactivity disorder (ADHD) on psychostimulants before pregnancy, continuation of psychostimulant medication during pregnancy compared with discontinuation showed no association with admissions for postpartum mental health conditions or new diagnoses of mood or anxiety disorders in the postpartum period.

METHODOLOGY:

• Researchers conducted a retrospective cohort study using data from a national commercial claims database from 2011 to 2021.
• They included 3676 participants aged 13-50 years with ADHD and singleton pregnancies who had deliveries at or after 20 weeks of gestation (median maternal age at delivery, 31 years) and psychostimulant prescriptions filled during the 6 months before pregnancy.
• The use of psychostimulants was categorized as no prescriptions (n = 1521), low or inconsistent prescriptions (n = 1899), or consistent prescriptions (n = 256) on the basis of prescription refill patterns of no refills or discontinuation of use and the proportion of days covered < 80% or ≥ 80% during pregnancy, respectively.
• Primary outcomes were postpartum admissions (emergency department or inpatient admissions) for mental health conditions and new diagnoses of mood or anxiety disorder.

TAKEAWAY:

• Overall, 3.3% of participants experienced at least one postpartum admission for mental health-related conditions in the year following childbirth, and 16.2% received a new diagnosis of mood or anxiety disorders.
• No significant association was found between continuation of psychostimulant medication during pregnancy and postpartum admissions for mental health conditions.
• Preexisting diagnoses of mental health conditions (adjusted rate ratio, 2.60; 95% CI, 1.76-3.90) and maternal medical comorbidities (adjusted rate ratio, 1.98; 95% CI, 1.33-2.93) were strong predictors of postpartum admissions for mental health conditions.
• A higher incidence of new mood or anxiety disorders was observed in those who continued psychostimulants than in those who discontinued. However, continuation of psychostimulants was not significantly associated with new diagnoses of mood or anxiety disorders in the postpartum period.

IN PRACTICE:

“[T]hese findings should not be interpreted as supporting routine discontinuation of ADHD medications during pregnancy. Psychostimulant treatment addresses core ADHD symptoms associated with daily functioning, and the decision to continue or discontinue medication requires individualized assessment of the risks and benefits for each patient’s unique clinical circumstances,” the authors wrote.

“[The findings] emphasize the need for individualized, evidence-based psychostimulant treatment decisions for pregnant people managing ADHD,” they concluded.

SOURCE:

The study was led by Kevin Y. Xu, MD, MPH, of the Department of Psychiatry and the Center for Advancing Health Services, Policy & Economics Research, at the Washington University School of Medicine in St Louis. It was published online on January 8, 2026, in Obstetrics & Gynecology.

LIMITATIONS:

The study did not assess mental health outcomes during pregnancy, focusing only on severe issues after childbirth. Prescription-fill data were used as a proxy for medication use, which may not accurately reflect actual consumption. Information on ADHD symptom severity, concurrent medications, and social determinants were lacking.

DISCLOSURES:

One author disclosed receiving payments to her institution from Gilead Sciences, Koko Medical, and Novocuff for unrelated research studies. Efforts for personnel were supported by the National Institutes of Health, Sorensen Foundation, and the National Council for Scientific and Technological Development.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.