Adverse sexual and reproductive health outcomes in female adolescents with ADHD and their associations with ADHD medication: a Swedish register-based study.

BACKGROUND

Females with attention-deficit/hyperactivity disorder (ADHD) are often diagnosed later than males and may experience disproportionate sexual and reproductive health risks. Evidence on whether ADHD medication mitigates adverse sexual and reproductive health (SRH) outcomes in female adolescents with ADHD remains limited.

OBJECTIVE

To examine the association between ADHD diagnosis, medication treatment and adverse SRH outcomes in adolescent girls.

METHODS

We conducted a population-based cohort study in Stockholm, Sweden, including females aged 4–20 years with an incident ADHD diagnosis or medication between 2011 and 2021. Individuals with ADHD were matched 1:5 to peers without ADHD based on sex, birth year and socioeconomic status. Adverse SRH outcomes were defined as sexually transmitted infections (STIs) or unwanted pregnancy. Cox proportional hazards models estimated associations between ADHD and adverse SRH outcomes. Within the ADHD cohort, we conducted a nested case-control study to assess associations between ADHD medication use and adverse SRH outcomes using conditional logistic regression.

RESULTS

Among 18 776 female adolescents with ADHD and 93 880 matched controls, 1787 (29.3 per 1000 person-years) and 4779 (15.2 per 1000 person-years) had an adverse SRH outcome recorded, respectively. ADHD was associated with an increased risk of adverse SRH outcomes (adjusted HR 1.70, 95% CI 1.59 to 1.81), with stronger associations for unwanted pregnancy than for STIs. Risk remained elevated in individuals without psychiatric comorbidity and was highest for those with comorbid substance use disorder. Longer ADHD medication use was associated with a progressively lower risk of adverse SRH outcomes (adjusted OR 0.64, 95% CI 0.44 to 0.94 for >5 years versus ≤1 year of treatment).

CONCLUSION

Female adolescents with ADHD have an increased risk of adverse SRH outcomes, independent of comorbidity. Longer ADHD medication duration is associated with lower risks.

CLINICAL IMPLICATIONS: The findings emphasise the importance of timely diagnosis and sustained management of ADHD in girls to reduce adverse SRH outcomes.