News & Analysis News From the Centers for Disease Control and Prevention Women’s Use of ADHD Drugs of the CDC’s Epidemic Intelligence Service Skyrockets and her coauthors argue more research is The number of privately insured women of needed. This is particularly important given child-bearing age filling prescriptions for at- the high rate of unintended pregnancy in the tention-deficit/hyperactivity disorder United States, they note. (ADHD) medications increased 344% be- “Half of all pregnancies in the United tween 2003 and 2015, according to the a re- States are unplanned, and women may be cent report by the US Centers for Disease taking prescription medicine early in preg- Control and Prevention (CDC). nancy before they know they are preg- To gauge how many women are using nant,” said Coleen Boyle, PhD, MSHyg, di- ADHD medications, the CDC analyzed a da- rector of the CDC’s National Center on Birth tabase of outpatient prescriptions filled by Defects and Developmental Disabilities in a privately insured women between the age news release. “Early pregnancy is a critical of 15 and 44 years during this period. The time for the developing baby. We need to MostpeopleinfectedwithhepatitisBde- number of women in the sample varied from better understand the safest ways to treat velop chronic infections and may not know 2.3 to 6.8 million during each of the years ADHD before and during pregnancy.” theyareinfected.Chronicinfectionsincrease analyzed. Based on the analysis, 4% of pri- Anderson and her coauthors cautioned theriskofdevelopingcirrhosisorlivercancer. vately insured women in this age bracket that the findings may not extend to women Since 1991, the ACIP has recommended uni- filled an ADHD prescription between 2003 covered by Medicaid, who account for 45% versalhepatitisBvaccinationsforallUSinfants and 2015. Use of these medications spiked of US births. as part of a comprehensive strategy to elimi- most drastically among younger age groups, natetransmissionofthehepatitisBvirus.The with a 700% increase among women aged Hepatitis B Recommendations Updated strategy also recommended routine testing 25 through 29 years and a 560% increase Healthy infants should be vaccinated with for hepatitis B surface antigen (HBsAg) for all among women aged 30 through 34 years. the hepatitis B within 24 hours of birth and pregnantwomen,prophylaxisforinfantsborn Mixed amphetamine salts (Adderall) was the physicians should not delay vaccination to infected mothers, routine vaccination of most commonly filled ADHD prescriptions in until after discharge, according to new older children and adolescents, and vaccina- the analysis, followed by lisdexamfetamine recommendations from the US Advisory tions for adults at risk. The new recommen- (Vyvanse), and methylphenidate (Ritalin). Committee on Immunization Practices dations emphasize steps to further reduce There has been little study of the poten- (ACIP) and the US Centers for Disease Con- mother-to-child transmission and increase tial effects of taking this class of medica- trol and Prevention (CDC). Previously, the vaccinations for vulnerable groups. tions during pregnancy on the mother or recommendations allowed for newborn The ACIP now advises that all newborns fetus. Lead author Kayla N. Anderson, PhD, vaccination after discharge. weighing at least 2000 g be vaccinated within 24 hours. The recommendation is in- Percentage of Women Aged 15 through 44 Years With Private Employer-Sponsored Insurance tended to avert potential mother-to-child Who Filled One or More Prescriptions for an Attention-Deficit/Hyperactivity Disorder (ADHD) transmission in cases in which the mother’s Medication, by Medication Class—United States, 2003–2015 infection may not have been identified dur- 4.5 ing pregnancy. Vaccinations for lower-birth 4.0 weight babies, who are less likely to achieve All ADHD prescriptions Stimulant medications seroprotection from vaccination at birth, 3.5 Nonstimulant medications may be delayed for a month. 3.0 Other new recommendations include: 2.5 testing pregnant women who are HBsAg positive for hepatitis B DNA; revaccinating 2.0 neonates born to mothers who are HBsAg 1.5 positive with a single dose if the infants fail 1.0 to respond to the initial vaccine series; post- 0.5 vaccination serological testing for infants whose mother’s HBsAg status is unknown; 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 andvaccinatingpeoplewithchronicliverdis- Year eases. − Bridget M. Kuehn, MSJ Source: Morb Mort Wkly Rep (MMWR). 2018;67(2):66-69. Note: Source references are available through embedded hyperlinks in the article text online. 762 JAMA February 27, 2018 Volume 319, Number 8 (Reprinted) jama.com © 2018 American Medical Association. All rights reserved. Percentage Filling Prescription James Cavallini/sciencesource.com
JAMA – American Medical Association
Published: Feb 27, 2018
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