Methylphenidate in Pregnancy
Orna Diav‐CitrinSvetlana ShechtmanJudy ArnonRebecka WajnbergCornelia BorischEvelin BeckJonathan L. RichardsonPina BozzoIrena NulmanAsher Ornoy
43
Citation
0
Reference
10
Related Paper
Citation Trend
Abstract:
Methylphenidate is a central nervous system stimulant medicinally used in the treatment of attention-deficit disorder with or without hyperactivity (ADD/ADHD). Data on its use in human pregnancy are limited. The primary objective of the study was to evaluate the risk of major congenital anomalies after pregnancy exposure to methylphenidate for medical indications.In a prospective, comparative, multicenter observational study performed in 4 participating Teratology Information Services (in Jerusalem, Berlin, Newcastle upon Tyne, and Toronto) between 1996 and 2013, methylphenidate-exposed pregnancies were compared with pregnancies counseled for nonteratogenic exposure (NTE) after matching by maternal age, gestational age, and year at initial contact.382 methylphenidate-exposed pregnancies (89.5% in the first trimester) were followed up. The overall rate of major congenital anomalies was similar between the groups (10/309 = 3.2% [methylphenidate] vs 13/358 = 3.6% [NTE], P = .780). The rates of major congenital anomalies (6/247 = 2.4% [methylphenidate] vs 12/358 = 3.4% [NTE], P = .511) and cardiovascular anomalies (2/247 = 0.8% [methylphenidate] vs 3/358 = 0.8% [NTE], P = .970) were also similar after exclusion of genetic or cytogenetic anomalies and limiting methylphenidate exposure to the period of organogenesis (weeks 4-13 after the last menstrual period). There was a higher rate of miscarriages and elective terminations of pregnancy in the methylphenidate group. Significant predictors for the miscarriages using Cox proportional hazards model were methylphenidate exposure (adjusted hazard ratio [HR] = 1.98; 95% CI, 1.23-3.20; P = .005) and past miscarriage (adjusted HR = 1.35; 95% CI, 1.18-1.55; P < .001).The present study suggests that methylphenidate does not seem to increase the risk for major malformations. Further studies are required to establish its pregnancy safety and its possible association with miscarriages.OBJECTIVE: To evaluate whether pregnancy outcomes associated with hypertensive disorders of pregnancy in twin pregnancies differ relatively from those in singleton pregnancy. METHODS: We conducted a retrospective, population-based cohort study of all women with a liveborn singleton or twin hospital birth in Ontario, Canada, between 2012 and 2019. Data were obtained from the Better Outcomes Registry & Network Ontario. Pregnancy outcomes were compared between women with and without hypertensive disorders of pregnancy in twin gestations, and separately in singleton gestations. Adjusted relative risks (aRRs) and 95% CIs were generated using modified Poisson regression and were compared between twins and singletons using relative risk ratios. RESULTS: Overall, 932,218 women met the study criteria, of whom 917,542 (98.4%) and 14,676 (1.6%) had singleton and twin gestations, respectively. The incidence of hypertensive disorders of pregnancy was higher in women with twin compared with singleton gestations (14.4% vs 6.4%, aRR 1.85 [1.76–1.94]). Hypertensive disorders of pregnancy were associated with certain adverse outcomes in singleton gestations only and with other adverse outcomes in both the singleton and twin gestations, but the aRR was lower in twins. For example, preterm birth before 37 weeks of gestation (singletons: 15.2% [hypertensive disorders of pregnancy] vs 5.4% [no hypertensive disorders of pregnancy], aRR 2.42; twins: 67.5% [hypertensive disorders of pregnancy] vs 50.4% [no hypertensive disorders of pregnancy], aRR 1.30) and neonatal respiratory morbidity (singletons: 16.3% [hypertensive disorders of pregnancy] vs 8.7% [no hypertensive disorders of pregnancy], aRR 1.50; twins: 39.8% [hypertensive disorders of pregnancy] vs 32.7% [no hypertensive disorders of pregnancy], aRR 1.13). These findings persisted in the subgroups of women with preeclampsia and early-onset preeclampsia. CONCLUSIONS: Although the absolute risk of adverse maternal and neonatal outcomes is higher in twin compared with singleton pregnancies, the incremental risk of adverse outcomes associated with hypertensive disorders in twin pregnancies is lower than the incremental risk in singleton pregnancies. These findings may be attributed in part to the higher baseline risk of preterm birth and adverse maternal and perinatal outcomes in twin compared with singleton pregnancies.
Singleton
Twin Pregnancy
Cite
Citations (17)
Objective. To evaluate the relationship between attention-deficit hyperactivity disorder (ADHD) and injuries and to verify whether methylphenidate (MPH), is associated with decreasing the risk of injuries. Methods. A retrospective cohort study using the computerized database of Maccabi Healthcare Services. The ADHD cohort included all children between 12 and 20 years of age, newly diagnosed with ADHD between 2003 and 2013. The comparison cohort was composed of children who were not diagnosed with ADHD. The primary outcome was traumatic injuries. A Cox proportional hazard regression analysis was conducted to estimate ADHD effects on the risk of injuries. We also conducted a nested case-control study to examine how MPH influences this relationship. Results. A total of 59 798 children were included in the cohort study; 28 921 were classified as exposed (ADHD cohort) and 30 877 were unexposed. The traumatic injuries incidence in the exposed group was significantly higher (adjusted hazard ratio = 1.63 [95% confidence interval = 1.60-1.66]). Similar increased risk was documented also for severe injuries (adjusted hazard ratio = 1.72 [1.59-1.86]). MPH use was significantly associated with 28% lower injury events. Therapy groups were significantly associated with 29% to 40% lower injuries rate for medium- or long-acting MPH. The intensity of therapy was significantly associated with 29% to 33% lower injury rate when the intensity was lower than 0.69 mg/kg/day. Conclusion. Children with ADHD have a 60% increased odds of experiencing an injury. Treatment with MPH reduced the risk by up to 28%. The individual and financial cost secondary to injuries, underscores the public health significance of this problem. Injury prevention should be considered in clinical evaluation of MPH risks and benefits, beyond the conventional consideration of enhancing academic achievements.
Rate ratio
Cite
Citations (6)
Abstract. A review of 1 000 pregnancies in which routine early pregnancy scanning was performed is reported. Ultrasound predicted accurately (to within ±14 days) the date of confinement in more than 90% of women who were unsure of their dates. Clinical estimation of gestation age compared well with ultrasound report in 90% of singleton pregnancies. Scanning diagnosed 3 out of 4 lethal congenital abnormalities in early pregnancy. The diagnosis of multiple pregnancy and placenta praevia have no immediate clinical implication in early pregnancy. Early pregnancy scan is recommended for women who are uncertain of their last menstrual period and for those with identified early pregnancy risks. Routine use of ultrasonography in early pregnancy should be related to the identified need of the population served and should be employed with caution. Where the policy of routine scanning is adopted, optional information is obtained when the procedure is carried out between the 14th and 18th week of gestation. Clinical pelvic examination in early pregnancy remains a valuable practice for the estimation of gestational age.
Early pregnancy factor
Cite
Citations (7)
The study deals with the clinical and laboratory manifestations of mild and moderate forms of depending on the gestational period in 69 pregnant women aged 18 to 41 (28.5 +/- 6.9), hospitalized with a COVID-19 diagnosis. The patients under study exhibited no significant differences in clinical symptoms and main laboratory data, including coagulogram (p >0.05) throughout three trimesters of pregnancy. The severity of in pregnant women most likely depends on the presence of concomitant extragenital pathology and burdened gynecological history (pathology of previous pregnancies and childbirth) rather than on gestational period (pathology of previous pregnancies and childbirth), since more often these pathologies occurred in pregnant women with moderate COVID-19. The research showed that women in all three trimesters of pregnancy showed a significant increase (p <0.05) in C-reactive protein, a specific marker of inflammation, the findings, obtained in the 2nd and 3rd trimesters of pregnancy (26.7 +/- 21.97 and 32.7 +/- 26.5 mg/l) insignificantly (p1-3 = 0.056, p2-3 = 0.231) exceeded those, observed in the 1st trimester (14.8 +/- 26.9). Copyright (C) 2013 - All Rights Reserved - Pharmacophore
Concomitant
Gestational period
Cite
Citations (0)
Cite
Citations (4)
We investigated whether nonsurgical termination of pregnancy after 14 weeks of gestation increases the risk of preterm delivery in a subsequent pregnancy. We conducted a two-centre retrospective case-control study. Patients who underwent non-surgical termination of pregnancy after 14 weeks of gestation between 2012 and 2015 and who gave birth after 14 weeks of gestation to a live-born singleton infant were included. Control patients were those who gave birth after 37 weeks of gestation (the same month as a case patient) and had a second delivery of a singleton foetus after 14 weeks of gestation. The primary outcome was preterm delivery during the second pregnancy period. We included 151 cases and 302 controls and observed 13 (8.6%) preterm births during the second pregnancy in the case group versus 8 (2.6%) (odds ratio: 3.62; 95% confidence interval: 1.40–8.65, p < .001) in the control group. This result remained significant after multivariate analysis. Impact statementWhat is already known about this topic? Many studies have evaluated the association between first-trimester surgical or non-surgical termination of pregnancy and the risk of preterm birth in the subsequent pregnancy. However, no study has evaluated the association between second- or third-trimester non-surgical termination of pregnancy due to foetal disease and the risk of preterm birth in the subsequent pregnancy. A small number of studies have included a small proportion of patients who previously underwent non-surgical termination of pregnancy after 14 weeks of gestation and later experienced first-trimester termination during their second pregnancy. These studies focussed on the impact of the interpregnancy interval or pharmacological induction of labour on the risk of preterm delivery in the subsequent pregnancy.What did the results of this study add? This is the first study to specifically evaluate the association between second- and third-trimester non-surgical terminations of pregnancy and the risk of preterm birth in the subsequent pregnancy. When compared with term birth, nonsurgical termination of pregnancy was associated with the risk of spontaneous preterm birth and hospitalisation in the neonatal intensive care unit in the subsequent pregnancy.What are the implications of these findings for clinical practice and further research? Further studies are required to confirm our results, but information delivered to patients with a late termination of pregnancy and during their pregnancy follow-up for the subsequent pregnancy could be modified to provide this information.
Cite
Citations (1)
The definition of prolonged pregnancy according to international guidelines is 42 completed weeks or more than that from the first date of last menstrual period. Although 42 completed weeks is used as cut off it is not an absolute threshold. Accurate estimation of gestational age and expected date of delivery is important for successful outcome of pregnancy. Because both maternal and fetal morbidity increase once pregnancy goes beyond the dates.
AIM OF THE STUDY:
1. To analyses the optimum period of intervention in pregnancy beyond the
expected date of delivery.
2. To study the fetal and maternal outcome.
3. To study the mode of delivery in pregnancy beyond dates.
MATERIALS AND METHODS:
The study done in institute of obstetrics and gynecology in Egmore MMC in 2016. It is a prospective study. Pregnant women which includes pregnancy beyond 40 weeks. Patients were recruited based on inclusion criteria.
From this analysis:
More number induction is seen beyond 40weeks of gestation compared to term pregnancy. As with more induction more number Caesarian rate is seen in pregnancy beyond 40weks of gestation. In this study there is increased neonatal and perinatal morbidity beyond 40 weeks of gestation.
CONCLUSION:
Postdated pregnancies should be correctly diagnosed. Properly planned and effective management required. As the perinatal morbidity is more in postdated pregnancy careful intrapartum monitoring should be done. Proper monitoring will found that hypoxic fetus at an early time.
Caesarian section
Cite
Citations (0)
In Brief OBJECTIVE: To estimate the risk of stillbirth in a second pregnancy when previous stillbirth, preterm, and small-for-gestational age (SGA) births occurred in the previous pregnancy. METHODS: This was a population-based cohort study in New South Wales Australia from 2002 to 2006. Singleton births in a first pregnancy were linked to a second pregnancy using data from the New South Wales Midwives Data Collection and the New South Wales Perinatal Death Database. Deaths were classified according to the Perinatal Mortality Classifications of the Perinatal Society of Australia and New Zealand. Crude and adjusted hazard ratios were estimated using a proportional hazards model. RESULTS: Delivery of an SGA newborn in the first pregnancy was associated with increased risks of stillbirth in a second pregnancy (hazard ratio 1.73, 95% confidence interval [CI] 1.15–2.60) and risk was further increased with prematurity (hazard ratio 5.65, 95% CI 1.76–18.12). Stillbirth in a first pregnancy had a nonsignificant association with stillbirth in the second pregnancy (hazard ratio 2.03, 95% CI 0.60–6.90). For women aged 30–34 years, the absolute risk of stillbirth up to 40 completed weeks of gestation was 4.84 per 1,000 among women whose first pregnancy was a stillbirth and 7.19 per 1,000 among women whose first pregnancy was preterm and SGA. CONCLUSION: Delivering an SGA and preterm neonate in a first pregnancy is associated with greater risks for stillbirth in a second pregnancy than delivering a previous stillbirth. All factors merit improved surveillance in a subsequent pregnancy, and research should address underlying factors common to all three outcomes. LEVEL OF EVIDENCE: II Risks of stillbirth in a second pregnancy are greater when the previous neonate was small for gestational age and preterm compared with a previous stillbirth.
Cite
Citations (8)
To estimate whether there is an association between second-trimester cervical length and prolonged pregnancy (defined as delivery at or beyond 41 weeks of gestation).This is a cohort study of nulliparous women with a singleton pregnancy who underwent routine cervical length measurement between 18 and 24 weeks of gestation. Women were divided into quartiles by cervical length and the association with prolonged pregnancy was evaluated in bivariable and multivariable analyses. A planned secondary analysis included only women who achieved at least 39 weeks of gestation.During the study period, a total of 9,165 women met inclusion criteria, of whom 1,481 (16.2%) had a prolonged pregnancy. Women in increasing cervical length quartiles were more likely to experience a prolonged pregnancy (12.9%, 15.8%, 17.1%, 18.6%, P<.001). This association remained significant when controlling for possible confounding variables. An analysis confined to women who achieved at least 39 weeks of gestation was consistent with the overall analysis.Increasing second-trimester cervical length is associated with an increased likelihood of having a prolonged pregnancy in nulliparous women.II.
Quartile
Cite
Citations (6)
A 31-year-old woman with a history of stillbirth due to placental abruption at 29 weeks’ gestation and one first trimester miscarriage documented a continuous record of her perceived fetal movements from 28 to 38 weeks’ gestation. Repeated ultrasound examinations confirmed a viable pregnancy, with normal growth, liquor volume and Doppler profile. She delivered a healthy male infant at 38 weeks and 3 days’ gestation. The data collected give a detailed record of fetal activity in a healthy pregnancy. Perceived fetal activity increased as pregnancy progressed and was greatest in the evenings. We also found that clusters of movements, which have previously been reported as protective against stillbirth, were felt earlier on in pregnancy.
Placental abruption
Fetal movement
Cite
Citations (0)