(320) The Risk of Postpartum Depression Based on Attention-Deficit/Hyperactivity Disorder Medication Use During Pregnancy

Background: Attention-Deficit/Hyperactivity Disorder (ADHD) is recognized as a significant risk factor for postpartum depression (PPD). Despite this, the safety of ADHD medication during pregnancy is still debated, with studies presenting conflicting evidence.

Objectives: To assess the association between treating ADHD with medication during pregnancy and the risk of PPD among women diagnosed with ADHD prior to pregnancy.

Methods: We implemented a 1:1 propensity score (PS) matched cohort study included women who had experienced childbirth using the claims database, which covers about 5 million pregnancies in Korea from January 1, 2016, to December 31, 2022. The study population consisted of women aged 18 to 49 years who were diagnosed with ADHD (International Classification of Diseases 10th revision, ICD-10-CM code F900) before their pregnancy. The cohort entry (index date) was the delivery date. ADHD treatment was defined as having been prescribed medication (methylphenidate, atomoxetine, or clonidine) during pregnancy. The outcome was postpartum depression (PPD) with primary diagnosis code (ICD-10-CM: F31-34, F38-39, F412, F53). PPD history was excluded for the year prior to the delivery date. Patients were followed up to one year or until experiencing a PPD or death from index date. Matching was conducted with the greedy matching methods (caliper width 0.1 on the PS scale) included confounders such as age group, types of birth (vaginal delivery vs. cesarean section), or obstetric history (primipara vs. multipara). A Cox proportional hazards regression was performed to estimate hazard ratio (HR) and 95% confidence intervals (95% CIs).

Results: A total of 1,696 eligible populations were included for analysis. Among them, of 557 were ADHD treatment group and 1,119 were non-treatment group. After well balanced PS matching, 1,154 had ADHD treatment group or non-treatment group. The mean age was 31.2 (±5.3) years, and 58.9% were primipara. We identified 76 and 162 PPD cases during a total of 538.0 and 469.6 person-years of follow-up respectively. The adjusted HR was 0.45 (95% CI: 0.32¬-0.55). The risk of developing PPD is 55% lower in the ADHD treatment group compared to those without treatment group.

Conclusions: There was a potential association between the ADHD medication treatment and a reduced risk of PPD during the pregnancy. Our study findings could support as evidence for the continuation of ADHD medication treatment during pregnancy. Further studies are needed that considering other psychiatric characteristics.