USE OF AMFETAMINES IN PREGNANCY

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(Date of issue: September 2012, Version: 1)

This is a UKTIS monograph for use by health care professionals. For case-specific advice please contact UKTIS on 0344 892 0909. To report an exposure please download and complete a pregnancy reporting form. Please encourage all women to complete an online reporting form.

Summary

The term ‘‘amfetamines’’ denotes a class of compounds which have structural similarity to ephedrine and includes general amfetamine, dexamfetamines, methamfetamines (or metamfetamines) and the multiple amfetamine analogues.  They are potent sympathomimetic stimulants which exert both central and peripheral effects.  The main central effects of amfetamines include locomotor stimulation, anorexia, euphoria and excitement.  Peripheral effects such as increased blood pressure, excessive sweating and tremor also occur.  Amfetamines may be orally ingested, nasally inhaled, intravenously injected or smoked.

As with all drugs of abuse, it is often difficult to establish exactly which drug has been used.  Exposure to contaminants from illicit production is also a concern.  In addition, recreational drug users are generally considered more likely to display an increased incidence of underlying psychosocial and/or behavioural risk factors for adverse pregnancy outcome including use of other drugs (both legal and illegal), alcohol and tobacco.  Due to data confounding from these factors it is difficult to provide firm conclusions about the risk maternal amfetamine use during pregnancy poses to a developing fetus.

Prospective epidemiological studies into the fetal effects of maternal amfetamine abuse have not conclusively identified an increased risk of congenital malformation.  Increased risks of preterm delivery, low birth weight and small for gestational age deliveries have been suggested.  Where maternal abuse of amfetamine has been sustained throughout pregnancy, or where late gestational exposure has occurred, withdrawal effects in the neonate may occur.  Given the neurotoxic effects of amfetamines, there is concern that in utero exposure may present a risk factor for neurodevelopmental delay in the exposed infant.  However, the available data are limited and confounded and it is therefore not currently possible to describe the existence of an association.

Where amfetamine use has been sporadic, a significant increase in the risk of adverse pregnancy outcomes would not be expected.  However, other risk factors may be present in individual cases which may independently increase the risk of adverse pregnancy outcome.  Clinicians are reminded of the importance of consideration of such factors when performing case-specific risk assessments.  Where prolonged abuse of amfetamine has occurred, additional monitoring may be required.  Discussion with UKTIS is recommended in all cases.

This document is regularly reviewed and updated.  Only use UKTIS monographs downloaded directly from TOXBASE.org or UKTIS.org to be sure you are using the most up-to-date version.

This is a summary of the full UKTIS monograph for health care professionals and should not be used in isolation. The full UKTIS monograph and access to any hyperlinked related documents is available to health care professionals at www.toxbase.org.

If you have a patient with exposure to a drug or chemical and require assistance in making a patient-specific risk assessment, please telephone UKTIS on 0344 892 0909 to discuss the case with a teratology specialist.

If you would like to report a pregnancy to UKTIS please click here to download our pregnancy reporting form. Please encourage all women to complete an online reporting form.

Disclaimer: Every effort has been made to ensure that this monograph was accurate and up-to-date at the time of writing, however it cannot cover every eventuality and the information providers cannot be held responsible for any adverse outcomes of the measures recommended. The final decision regarding which treatment is used for an individual patient remains the clinical responsibility of the prescriber. This material may be freely reproduced for education and not for profit purposes within the UK National Health Service, however no linking to this website or reproduction by or for commercial organisations is permitted without the express written permission of this service. This document is regularly reviewed and updated. Only use UKTIS monographs downloaded directly from TOXBASE.org or UKTIS.org to ensure you are using the most up-to-date version.