May methylphenidate be used in late pregnancy?/nThe question concerns a 26-year-old woman who is pr

Fråga: May methylphenidate be used in late pregnancy? The question concerns a 26-year-old woman who is pregnant in week 35, and who suffers from Attention deficit hyperactivity disorder (ADHD) and borderline personality disorder. The treatment was started two years ago and has had a good effect on the symptoms. Because of the pregnancy, treatment was withdrawn which has resulted in a chaotic situation with severe insomnia and thoughts about death. The patient has children and it has been problematic to take care of them. She is presently treated as an inpatient.

Sammanfattning: Although the data is limited, no evidence has been found indicating risks for the child when the mother is given therapeutic oral doses in late pregnancy.

Svar: Methylphenidate is a small molecule, which likely crosses the placenta (1). Searching the literature, a study with a series of cases concerning suspected withdrawal symptoms in children to mothers who abused methylphenidate intravenously was found (2). It is not specified which symptoms the children had. Many factors may have had negative effects in this retrospective study, such as concomitant abuse of alcohol and other drugs and cigarette smoking, and causal relationships are difficult to establish.

No reports have been found about withdrawal symptoms in children to mothers who were given methylphenidate orally in therapeutic doses during late pregnancy.

The manufacturer has stated that symptoms may occur in patients when treatment is withdrawn, but that this may be due to the underlying disease (3).

The beneficial effects of treatment likely outweigh the possible risks in the present case.