Does ADHD increase risk of teenage birth?

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Attention-deficit/hyperactivity disorder (ADHD) is known to increase likelihood of risk-taking behaviors. A new Swedish study indicates that the condition is also associated with higher risk of teenage birth, which could have negative health consequences for both the mothers and their babies.

Published in JAMA Network Open, the findings are from an analysis of a nationwide cohort for which data had been collected in six longitudinal population-based registries in Sweden. The information reviewed reflected experience in all nulliparous women and girls who gave birth in the country from January 1, 2007 to December 31, 2014. The data were analyzed between October 7, 2018 and February 8, 2019.

Related: Behavioral health in pregnancy and postpartum

Outcomes of the study were maternal age at birth as well as body mass index, smoking habits, and psychiatric comorbidities. The authors looked at associations between ADHD in teens and risk factors for adverse obstetric and perinatal outcomes, such as smoking, underweight or overweight, and substance abuse.

The study included nearly 400,000 women and girls aged 12 to 50 who gave birth during the study time period. Of them, 1.7% had ADHD. 

The women and girls with ADHD were six times as likely to give birth before age 20 than the participants without the condition (odds ratio [OR] 6.23; 95% confidence interval [CI] 5.80-6.68). They were also more likely to smoke during the third trimester (OR, 6.88; 95% CI, 6.45-7.34), be underweight (body mass index [BMI] < 18.50 (OR, 1.29; 95% CI, 1.12-1.49) or overweight [BMI > 40.0 (OR, 2.01; 95% CI, 1.60-2.52), and to have an alcohol or substance abuse disorder (OR, 20.25; 95% CI, 18.74-21.88). Looking at educational levels, the authors found that nearly half (48.6%) of the women and girls with ADHD had ≤ 10 years of education versus 14.5% of those without ADHD.

The authors noted the lack of research on prevalence of teenage pregnancy in women and girls with ADHD and underscored that theirs was a large-scale epidemiologic study designed to address modifiable risk factors associated with adverse obstetric and perinatal outcomes. They said their findings, “argue for an improvement in the standard of care for women and girls with ADHD, including active efforts to prevent teenage pregnancies and address comorbid medial and psychiatric conditions.” 

The researchers hypothesized that patients with ADHD may “receive inadequate contraceptive counseling, inadequately response to counseling, fail to access or act on counseling, or experience more adverse effects from hormonal contraceptives.” Their results, they concluded, “suggest that delaying first childbirth until after age 20 years may be advantageous for women with ADHD in terms of the risks associated with smoking and underweight for the offspring.”