Dexamphetamine substitute‐prescribing in pregnancy: a 10‐year retrospective audit

Background: In the UK dexamphetamine has been used widely as a treatment for amphetamine users. We sought to study the effects of illicit amphetamine use on pregnancy, and to evaluate the safety and effectiveness of prescribing to pregnant users.

Method: The ante‐natal care and birth outcomes of 47 amphetamine‐using women who were prescribed dexamphetamine and 41 who were not, were compared with each other, and with local population norms. Analyses by dose of dexamphetamine were performed. Data was also collected for two equivalent samples of heroin users.

Results: The prescribed amphetamine and heroin users received adequate antenatal care. Despite this there was a high rate of low birth weight in both groups. It is doubtful that prescribed dexamphetamine contributed substantially to these adverse outcomes in the amphetamine users, as they were very similar in those not prescribed to. Also, there was no association demonstrated with duration of prescribing or maximum dose. ‘On‐top’ use was the best predictor of adverse birth outcomes.

Conclusions: Dexamphetamine substitution delivered alongside a specialist midwifery service is successful at ensuring clients receive adequate antenatal care, but should be initiated with caution and used as a last‐line treatment. Clients should be informed of possible risks, including those relating to continued use of street‐drugs.