Perinatal Psychiatric Risk Higher in Mothers With ADHD

Key Takeaways

• In an Ontario cohort of more than 1 million mothers, pre-pregnancy ADHD was associated with significantly higher adjusted risk of any non-ADHD-related psychiatric contact from conception through 365 days postpartum.
• Adjusted risk was elevated across anxiety, bipolar, depressive, psychotic, and substance/alcohol use disorder contacts.
• Psychiatric ED visits and hospitalizations were both more frequent among mothers with pre-pregnancy ADHD.

Attention-deficit/hyperactivity disorder (ADHD) affects about 1 in 50 women of reproductive age, and pregnancy through the first postpartum year is a period when sleep disruption, stress, and mental illness can intensify. In a population-based Ontario cohort, investigators used health administrative data from 2013 to 2023 to compare 22,995 mothers with pre-pregnancy ADHD and 1,028,038 mothers without it.

The main outcome was any non-ADHD-related mental healthcare system contact from conception through 365 days postpartum. Secondary outcomes included contacts related to anxiety, bipolar, depressive, psychotic, and substance/alcohol use disorders, along with psychiatric emergency department (ED) visits, hospitalizations, and intentional self-injury. Adjusted analyses accounted for maternal age, parity, immigration status, income quintile, rurality, preconception mental illness, infant sex, and year of delivery.

After adjustment, pre-pregnancy maternal ADHD was associated with higher risk of any psychiatric disorder contact, with adjusted relative risk (aRR) 1.35 and 95% confidence interval (CI) 1.33-1.38. Risk was also elevated across every psychiatric disorder subtype assessed, with aRRs ranging from 1.34 to 2.37.

More acute psychiatric outcomes showed the same pattern. Psychiatric ED visits were associated with aRR 1.98 and 95% CI 1.88-2.08, psychiatric hospitalization with aRR 2.26 and 95% CI 2.06-2.48, and intentional self-injury with aRR 2.16 and 95% CI 1.88-2.49.

Clinician Questions

What perinatal time window did the Ontario ADHD cohort study evaluate for psychiatric healthcare contact?

The analysis followed mothers from conception through 365 days postpartum and defined the primary endpoint as any non-ADHD-related mental healthcare system contact during that interval. That endpoint therefore covered both pregnancy and the first postpartum year.

Does pre-pregnancy ADHD appear to cause perinatal psychiatric illness in this Ontario cohort?

No. This observational population-based cohort showed an association between pre-pregnancy ADHD and greater perinatal psychiatric healthcare contact, not proof that ADHD caused psychiatric illness or service use. The adjusted analyses accounted for maternal age, parity, immigration status, income quintile, rurality, preconception mental illness, infant sex, and year of delivery, but those adjustments do not remove the limits of observational inference. Because the data came from Ontario, Canada, applicability to U.S. practice settings may vary.

Which psychiatric outcomes were included beyond overall mental health contact in mothers with pre-pregnancy ADHD?

Secondary outcomes included healthcare contacts for anxiety, bipolar, depressive, psychotic, and substance/alcohol use disorders, along with severe psychiatric outcomes of psychiatric ED visits, hospitalization, and intentional self-injury. This describes the study's outcome framework rather than a separate set of causal endpoints.