Association of Attention-Deficit/Hyperactivity Disorder With Teenage Birth Among Women and Girls in Sweden

Importance: Attention-deficit/hyperactivity disorder (ADHD) is associated with a plethora of adverse health outcomes throughout life. While Swedish specialized youth clinics have carefully and successfully targeted risk of unplanned pregnancies in adolescents, important risk groups, such as women and girls with ADHD, might not be identified or appropriately assisted by these interventions. Objectives: To determine whether women and girls with ADHD are associated with increased risk of teenage birth compared with their unaffected peers and to examine the association of ADHD with risk factors for adverse obstetric and perinatal outcomes, such as smoking, underweight or overweight, and substance use disorder. Design, Setting, and Participants: This nationwide cohort study included data from 6 national longitudinal population-based registries in Sweden. All nulliparous women and girls who gave birth in Sweden between January 1, 2007, and December 31, 2014, were included. Data analyses were conducted from October 7, 2018, to February 8, 2019. Exposures: Women and girls treated with stimulant or nonstimulant medication for ADHD (Anatomic Therapeutic Chemical classification code N06BA) in the Swedish Prescribed Drug Register between July 1, 2005, and December 31, 2014. Main Outcomes and Measures: Maternal age at birth. Secondary outcome measures were body mass index, smoking habits, and psychiatric comorbidities. Results: Among 384 103 nulliparous women and girls aged 12 to 50 years who gave birth between 2007 and 2014 included in the study, 6410 (1.7%) (mean SD age, 25.0 5.5 years) were identified as having ADHD. The remaining 377 693 women and girls without ADHD (mean SD age, 28.5 5.1 years) served as the control group. Teenage deliveries were more common among women and girls with ADHD than among women and girls without ADHD (15.3% vs 2.8%; odds ratio OR, 6.23 95% CI, 5.80-6.68). Compared with women and girls without ADHD, those with ADHD were more likely to present with risk factors for adverse obstetric and perinatal outcomes, including smoking during the third trimester (OR, 6.88 95% CI, 6.45-7.34), body mass index less than 18.50 (OR, 1.29 95% CI, 1.12-1.49), body mass index more than 40.00 (OR, 2.01 95% CI, 1.60-2.52), and alcohol and substance use disorder (OR, 20.25 95% CI, 18.74-21.88). Conclusions and Relevance: This study found that women and girls with ADHD were associated with an increased risk of giving birth as teenagers compared with their unaffected peers. The results suggest that standard of care for women and girls with ADHD should include active efforts to prevent teenage pregnancies.