---
title: "Atomoxetine and Stimulant Use in Pregnancy: Maternal and Birth Outcome Findings"
id: "womens-mental-health-0-atomoxetine-and-stimulants-during-pregnancy-what-do-we-know-about-pregnancy"
canonical_url: "https://medichelpline.com/clinical-feed/womens-mental-health-0-atomoxetine-and-stimulants-during-pregnancy-what-do-we-know-about-pregnancy"
content_type: "clinical_feed_article"
specialty: "Pharmacology"
source_name: "Women's Mental Health"
source_url: "https://womensmentalhealth.org/posts/atomoxetine-stimulants-pregnancy-outcomes/"
published_at: "2026-09-02T17:58:24.000Z"
evidence_level: "Verified Feed"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Atomoxetine and Stimulant Use in Pregnancy: Maternal and Birth Outcome Findings
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/womens-mental-health-0-atomoxetine-and-stimulants-during-pregnancy-what-do-we-know-about-pregnancy
- **Specialty:** [Pharmacology](https://medichelpline.com/clinical-feed/pharmacology.md)
- **Primary Source:** Women's Mental Health
- **Source URL:** [Original Journal Publication](https://womensmentalhealth.org/posts/atomoxetine-stimulants-pregnancy-outcomes/)
- **Published At:** 2026-09-02T17:58:24.000Z
- **Evidence Rating:** Verified Feed
## Executive GIST (TL;DR)
- A large retrospective electronic health record study (TriNetX) evaluated **32,152 pregnancies** in women with prior stimulant prescriptions: 8,394 continued stimulants, 405 switched to atomoxetine, and 23,353 discontinued both during pregnancy. - The study compared outcomes among women who continued stimulants vs. those who discontinued (controls), stimulants vs. atomoxetine, and atomoxetine vs. controls, using propensity-score matching and logistic regression. - Stimulant exposure during pregnancy was associated with modestly higher adjusted odds of **gestational hypertension**, **pre-eclampsia/eclampsia**, **preterm delivery**, and **spontaneous abortion/miscarriage** compared with women who discontinued stimulants. - Some outcomes were less likely with stimulant exposure: lower odds of **fetal growth restriction**, **large for gestational age**, **cesarean section**, and **induction of labor** compared with unexposed controls. - Compared with atomoxetine, stimulants showed higher odds for several outcomes (gestational diabetes, gestational hypertension, placental abruption, placenta previa, large for gestational age, and miscarriage), but the atomoxetine group was small (n=405) and had markedly different baseline comorbidities. - Atomoxetine versus controls showed increased odds for fetal growth restriction, large for gestational age, instrumental delivery, and induction of labor; however, atomoxetine users had higher rates of depression, anxiety, bipolar disorder, substance use, smoking, and alcohol use. - Average medication exposure measured by proportion of days covered (PDC) was 38.7% for stimulants and 22.5% for atomoxetine during pregnancy. - The authors emphasize that this was an **observational study**; associations do not establish causation. Baseline differences and confounding by indication limit interpretation, particularly for comparisons involving the small atomoxetine group. - Clinical decisions should be individualized, balancing potential medication risks against consequences of inadequately treated ADHD in pregnancy.
## Clinical Analysis & Structured Key Points
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Masterclass](https://womensmentalhealth.org/thenpmasterclass/) * [The Psychiatry Collective](https://womensmentalhealth.org/thepsychiatrycollective/) * [Collective Members](https://womensmentalhealth.org/psychiatrycollectiveproviderlistings/) * [Resources](https://womensmentalhealth.org/resource/) * [Contact](https://womensmentalhealth.org/about/contact-us/) * [Contact Us](https://womensmentalhealth.org/about/contact-us/) * [Support Our Program](https://giving.massgeneral.org/donate/ammon-pinizzotto-center/) Search Results for **{phrase}** (**{results_count}** of **{results_count_total}**) Displaying **{results_count}** results of **{results_count_total}** Generic filters Exact matches only Search in title Search in content Search in excerpt # Atomoxetine and Stimulants During Pregnancy: What Do We Know About Pregnancy Outcomes? * September 2, 2026 # Atomoxetine and Stimulants During Pregnancy: What Do We Know About Pregnancy Outcomes? * [ADHD](https://womensmentalhealth.org/posts/category/adhd/) | [ADHD Medications](https://womensmentalhealth.org/posts/category/adhd-medications/) | [Pregnancy](https://womensmentalhealth.org/posts/category/pregnancy/) | [Pregnancy & Medications](https://womensmentalhealth.org/posts/category/pregnancy-medications/) | [Pregnancy Outcomes](https://womensmentalhealth.org/posts/category/pregnancy-outcomes/) | [Psychiatric Disorders During Pregnancy](https://womensmentalhealth.org/posts/category/psychiatric-disorders-during-pregnancy/) A new study examines pregnancy outcomes among women using stimulants or atomoxetine during pregnancy, finding modest increases in some complications with stimulant use while highlighting important limitations of observational data. ![Picture of Ruta Nonacs, MD PhD](https://secure.gravatar.com/avatar/ba5b1913ae575ce1bf08d0c2496601470228810f198fae6c3b7e2c211b1f5afe?s=100&d=mm&r=g) #### Ruta Nonacs, MD PhD ![](https://womensmentalhealth.org/wp-content/uploads/elementor/thumbs/AdobeStock_835187138-scaled-1-r7d303zfzi7rokooccxyfealgtf5fn8knjsez9s45g.jpeg) In This article * A large electronic health record study examined **32,152 pregnancies** among women who had used stimulant medication before pregnancy, including 8,394 who continued stimulants, 405 who used atomoxetine, and 23,353 who used neither medication during pregnancy. * Compared with women who discontinued ADHD medication, stimulant use during pregnancy was associated with **modestly higher odds of gestational hypertension, pre-eclampsia/eclampsia, preterm delivery, and miscarriage**. * Stimulant exposure was also associated with lower odds of several outcomes, including fetal growth restriction, cesarean delivery, and induction of labor. * The atomoxetine group had substantially higher rates of depression, anxiety, bipolar disorder, substance use, smoking, and alcohol use, making comparisons between atomoxetine and stimulants particularly difficult to interpret. * Because this was an **observational study** , the findings do not establish that ADHD medications caused the adverse outcomes. Treatment decisions during pregnancy should be individualized, weighing potential medication risks against the consequences of inadequately treated ADHD. Over the last two decades, there has been a significant increase in stimulant prescriptions among adults in the United States, particularly among women of reproductive age. As a result, clinicians are increasingly seeing women with questions about the use of ADHD medications during pregnancy. While data regarding the risk of congenital malformations with stimulant exposure are largely reassuring, information on maternal and fetal outcomes is more limited and has been somewhat inconsistent. Studies examining pregnancy outcomes differ considerably in their methodology. With observational studies investigating medication use during pregnancy, outcomes in exposed pregnancies are compared to outcomes in unexposed pregnancies; however, women who elect to continue medication during pregnancy may differ from those who do not use or discontinue treatment in ways that can independently affect pregnancy outcomes. These differences can make it difficult to determine whether an observed association is attributable to the medication itself or to characteristics of the women receiving treatment. Several recently published studies have examined the relationship between prenatal exposure to ADHD medications and pregnancy outcomes. In this three-part series, we review these studies in detail, with the goal of helping clinicians provide an accurate assessment of the potential risks and benefits of ADHD medication use during pregnancy. * **In Part 1 of this series** , we reviewed a large claims-based study by[ Hasan and colleagues](https://journals.sagepub.com/doi/abs/10.1177/10870547251397034) examining pregnancy outcomes according to the timing of stimulant exposure. * **In Part 2** , we review a [recent study by Tuan and colleagues](https://pubmed.ncbi.nlm.nih.gov/42500274/) examining pregnancy outcomes among women who continued stimulant treatment or switched to atomoxetine during pregnancy. * **In Part 3** , we will review meta-analyses examining maternal and fetal outcomes in pregnancies exposed to ADHD medications. ## **Study Design** [Tuan and colleagues](https://pubmed.ncbi.nlm.nih.gov/42500274/) conducted a retrospective observational study using electronic health record data from the TriNetX Research Network. The database includes more than 80 million patients from 103 participating healthcare organizations, predominantly in the United States. The researchers identified adult women who delivered between 2010 and 2022 and who had received at least two stimulant prescriptions before pregnancy. An important feature of this study is that **all women included in the analysis had received a prescription for stimulant treatment before pregnancy**. This allowed the researchers to compare women who continued stimulant treatment during pregnancy with women who discontinued treatment or switched to atomoxetine, rather than comparing stimulant users with a population that had never used stimulants. The final analysis included 32,152 pregnancies: * 8,394 women (26.1%) continued prescribed stimulants during pregnancy * 405 women (1.3%) switched to atomoxetine during pregnancy * 23,353 women (72.6%) received neither stimulants nor atomoxetine during pregnancy The stimulant group included women who received at least two stimulant refills during pregnancy and no atomoxetine. The atomoxetine group included women who received at least two atomoxetine prescriptions during pregnancy and no stimulants. Women who received only one prescription for either medication were excluded. The researchers also calculated the **proportion of days covered (PDC)** during pregnancy to account for differences in the duration and consistency of medication exposure. The average PDC was 38.7% in the stimulant group and 22.5% in the atomoxetine group. The following outcomes were assessed using electronic health record data: * prenatal maternal complications, including gestational diabetes, gestational hypertension, and pre-eclampsia/eclampsia * placental complications, including placental abruption and placenta previa * fetal growth restriction and large-for-gestational-age infants * labor and delivery complications, including cesarean section, instrumental delivery, shoulder dystocia, and induction of labor * birth-related outcomes, including preterm delivery and spontaneous abortion/miscarriage Propensity-score matching was used to reduce differences in baseline characteristics between the comparison groups, followed by logistic regression to estimate the likelihood of individual adverse pregnancy outcomes. ## **Outcomes Associated with Stimulant and Atomoxetine Exposure** While the authors report, “The stimulant group was 1.2–3.1 times more likely to develop prenatal maternal, placental, and birth-related complications than the atomoxetine and control groups,” this is an oversimplification of the findings. To better understand the findings and the clinical relevance of the study, it is essential to examine specific outcomes and comparison groups. ### **Stimulants vs. Unexposed Controls (n=8,394 vs. 23,353)** In this comparison, women who continued stimulant treatment during pregnancy were compared with women who had a history of stimulant treatment before pregnancy but received neither stimulants nor atomoxetine during pregnancy. Rather than examining outcomes of all pregnancies, the study focused on women who had received treatment with a stimulant. Because the control group also had a history of stimulant treatment, this type of comparison may help to reduce some of the differences between women with ADHD or other indications for stimulant treatment and women who have never used stimulants. However, women who discontinue medication during pregnancy may still differ in important ways from those who continue treatment. * **Increased risk with stimulants:** * Gestational hypertension (aOR 1.15, 95% CI 1.08–1.22) * Preeclampsia/eclampsia (aOR 1.36, 95% CI 1.27–1.45) * Placenta previa (aOR 1.31, 95% CI 1.19–1.45) * Preterm delivery (aOR 1.34, 95% CI 1.24–1.46) * Spontaneous abortion/miscarriage (aOR 1.48, 95% CI 1.41–1.55) * **Decreased risk with stimulants:** * Gestational diabetes (aOR 0.90, 95% CI 0.83–0.97) * Fetal growth restriction (aOR 0.74, 95% CI 0.64–0.85) * Large for gestational age (aOR 0.87, 95% CI 0.78–0.97) * Cesarean section (aOR 0.87, 95% CI 0.83–0.92) * Induction of labor (aOR 0.58, 95% CI 0.48–0.71) The increased risks associated with stimulant exposure were generally modest. For example, the odds of pre-eclampsia/eclampsia were approximately 36% higher and the odds of preterm delivery approximately 34% higher among women who continued stimulants compared with those who discontinued treatment. ### **Stimulants vs. Atomoxetine (n=8,394 vs. 405)** In this comparison, women taking stimulants during pregnancy were compared with women who switched from stimulant treatment before pregnancy to atomoxetine during pregnancy. * **Increased risk with stimulants:** * Gestational diabetes (aOR 1.28, 95% CI 1.01–1.64) * Gestational hypertension (aOR 1.25, 95% CI 1.08–1.45) * Placental abruption (aOR 3.43, 95% CI 2.12–5.56) * Placenta previa (aOR 2.45, 95% CI 1.81–3.31) * Large for gestational age (aOR 1.76, 95% CI 1.29–2.40) * Spontaneous abortion/miscarriage (aOR 3.06, 95% CI 2.65–3.52) * **Decreased risk with stimulants:** * Fetal growth restriction (aOR 0.46, 95% CI 0.39–0.54) * Cesarean section (aOR 0.71, 95% CI 0.62–0.81) * Instrumental delivery (aOR 0.63, 95% CI 0.47–0.85) * Induction of labor (aOR 0.24, 95% CI 0.18–0.30) The differences between stimulants and atomoxetine appear larger than those observed when stimulants were compared with the control group. However, these findings should **not** be interpreted as evidence that stimulants are inherently more dangerous than atomoxetine. The atomoxetine group was very small and differed substantially from both the stimulant and control groups in important ways. ### **Atomoxetine vs. Unexposed Controls (n=405 vs. 23,353)** Compared with women who received neither medication during pregnancy, atomoxetine exposure was associated with increased risk of several outcomes: * **Increased risk with atomoxetine:** * Fetal growth restriction (aOR 2.29, 95% CI 2.00–2.62) * Large for gestational age (aOR 1.94, 95% CI 1.71–2.21) * Instrumental delivery (aOR 15.0, 95% CI 11.7–19.3) * Induction of labor (aOR 9.49, 95% CI 7.90–11.4) * **Decreased risk with atomoxetine:** * Shoulder dystocia (aOR 0.63, 95% CI 0.47–0.85) The researchers found no significant differences between atomoxetine and the control group for other outcomes **How Should We Interpret These Findings?** The most consistent findings in this study were associations between stimulant exposure and increased risk of **gestational hypertension, pre-eclampsia/eclampsia, preterm delivery, and miscarriage**. The magnitude of these associations was generally modest when stimulants were compared with women who discontinued stimulant medications, with adjusted odds ratios ranging from approximately 1.15 to 1.48. These findings are consistent with previous research suggesting that stimulant exposure during pregnancy may be associated with increased risk of hypertensive disorders and preterm birth. The biological mechanism is also plausible. Prescription stimulants can increase blood pressure and cause blood vessel constriction, which could potentially affect uteroplacental blood flow. At the same time, this study cannot establish that stimulant exposure caused these outcomes. Women who continue stimulant treatment during pregnancy may differ from women who discontinue treatment in ways that are difficult to fully capture in electronic health record data. The comparison with atomoxetine is particularly difficult to interpret. At first glance, the substantially larger odds ratios for several outcomes might suggest that stimulants carry considerably greater risk than atomoxetine. However, the atomoxetine group was small and had markedly different baseline characteristics. Women in the atomoxetine group were more likely to have depression, anxiety, bipolar disorder, and substance use disorders, as well as several medical comorbidities than those in the control and stimulant groups. Thus, the larger differences observed when stimulants were compared with atomoxetine may reflect differences between the women receiving these medications rather than differences in the medications themselves. Interestingly, stimulant exposure was associated with **lower odds of fetal growth restriction** than either atomoxetine exposure or the control group. The authors also found low
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