While for decades attention deficit hyperactivity disorder (ADHD) was regarded as mostly a pediatric condition, it is apparent that many adults continue to be afflicted by this condition, and presently an estimated 30 %–40 % of patients continue with ADHD symptomatology into adulthood. With more adults using stimulants for ADHD, there is evidence of increased numbers using ADHD medications in pregnancy. Till recently the reports on ADHD medication safety have been sparse with insufficient power to address fetal safety. Methylphenidate has been a first line treatment for ADHD, with relatively large numbers of usage.

We conducted a scoping review and meta-analysis of observational cohort studies that compared malformation rates among offspring exposed to methylphenidate during early pregnancy, to the rates in the general population. Meta- analysis of 4 cohort studies with almost 3000 women exposed to methylphenidate only, and almost 3 million unexposed controls, yielded an OR of 1.26(95 % confidence interval 1.05–1.51) for major malformations, and 1.59 (95 % confidence interval 1.02–2.49) for cardiac malformations.

In conclusion, methylphenidate exposure in early pregnancy is associated with a small but significant increased risk for major malformations, which can be attributed mostly to increased risk of cardiac malformations. It may be advisable to consider fetal echocardiography in pregnant women using methylphenidate during pregnancy.

尽管几十年来注意力缺陷多动障碍（ADHD）主要被认为是一种儿科疾病，但显然许多成年人仍然受到这种疾病的困扰，目前估计有30％–40％的患者患有ADHD症状直至成年。随着越来越多的成年人使用兴奋剂治疗多动症，有证据表明怀孕期间使用多动症药物的人数增加。直到最近，关于多动症药物安全性的报道还很少，不足以解决胎儿安全问题。哌醋甲酯一直是多动症的一线治疗药物，使用量相对较大。

我们对观察性队列研究进行了范围回顾和荟萃分析，将妊娠早期暴露于哌醋甲酯的后代中畸形率与普通人群中的畸形率进行了比较。对4项队列研究的荟萃分析仅对将近3000名暴露于哌醋甲酯的妇女和将近300万未暴露的对照进行了研究，得出主要畸形的OR为1.26（95％置信区间1.05–1.51）和1.59（95％置信区间1.02–1.5）。 2.49）用于心脏畸形。

总之，怀孕早期的哌醋甲酯暴露与严重严重畸形的发生率虽小但显着升高，这主要归因于心脏畸形的发生率增加。建议在怀孕期间使用哌醋甲酯的孕妇考虑胎儿超声心动图检查。