An Investigation into the Use of Stimulant Therapy during Pregnancy

Introduction. A lack of documentation of stimulant use during pregnancy means that doctors have difficulty advising narcoleptic and hypersomnolent patients. Objectives. To investigate the use of stimulant therapy in narcoleptic and hypersomnolent patients during pregnancy. Method. A search of clinic letters at a tertiary sleep clinic identified women who became pregnant whilst receiving stimulant therapy between 01/09/1999 and 18/11/2010. Fifteen patients were included in a telephone survey. Results. There were 20 pregnancies. The reported advice received with regards to stimulant use was variable. In 7 pregnancies, medication was stopped preconceptually: 1 had a cleft palate and an extra digit 6 had good foetal outcomes. In 8 pregnancies, medication was stopped postconceptually: 1 had autism and attention-deficit hyperactivity disorder; 7 had good foetal outcomes. In 5 pregnancies, medication was continued throughout pregnancy: 2 ended in miscarriage; 1 was ectopic; 2 had good foetal outcomes. The most common symptom experienced was debilitating hypersomnolence. Conclusion. There are no standardised guidelines for use of stimulants during pregnancy. Women have significant symptoms during pregnancy for which there is an unmet clinical need. More research is needed into whether medication can be safely continued during pregnancy, and if not, when it should be discontinued. Better standardized advice should be made available. 1. Introduction In practice, the advice given to women with narcolepsy and idiopathic hypersomnolence is to discontinue stimulant therapy during pregnancy because of fear of potential teratogenicity. Some patients chose to remain on stimulant therapy during their pregnancy because of intolerable sleepiness. There is a lack of documentation on how women cope with their symptoms during pregnancy, and in practice, doctors find it difficult to advise these patients. At the tertiary sleep clinic used in this study, there are approximately 110 patients currently being followed up for narcolepsy and idiopathic hypersomnolence. 42 of those patients are females and of fertile age. Narcolepsy is a cause of excessive daytime sleepiness (EDS) distinguished by abnormal intrusions of rapid eye movement (REM) sleep such as cataplexy, sleep paralysis, and hypnagogic hallucinations during wakefulness [1]. Idiopathic hypersomnolence is also a cause of EDS but patients do not meet the diagnostic criteria for narcolepsy. There is sleep inertia; EDS, and naps are usually more prolonged than in narcolepsy and less refreshing [2]. The American Sleep