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Adhd Medication While Pregnant

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Lets Talk About Medication For Adhd While Pregnant

Danielle Berdhal, MD, OB/GYN, discusses if ADHD link means Tylenol is unsafe during pregnancy

Having a baby is a very exciting time in your life. It is also scary, overwhelming, and anxiety-provoking. And dont let social media or friends who say that pregnancy and motherhood are so amazing fool you. You already know how difficult it is to live with ADHD, and having ADHD is a risk factor for PMADS. But, as I mentioned earlier in the article, PMADS can be prevented, or at least minimized.

Ceasing Use Of Adhd Medication During Pregnancy And Breastfeeding

When a mother decides to stop taking ADHD medication during pregnancy and/or nursing, its helpful for her to educate her spouse or partner, other children, extended family members, and employer about this decision. Symptoms of hyperactivity, inattention, and/or impulsivity may return during pregnancy, and may take some people off guard.

Explain that you are stopping medication because you feel its best for your baby, and welcome any support they can offer bringing over some meals, reminding you of appointments, etc. You may also want to consider decreasing or eliminating certain responsibilities.

New Findings On Adhd Medications During Pregnancy

A study provides new insights into whether its safe both for infants and pregnant women if the mother takes certain stimulant medications for attention-deficit hyperactivity disorder during pregnancy.

The paper was published online November 1, 2017 and appears in the December issue of Obstetrics & Gynecology.

The study, led by Jacqueline Cohen, postdoctoral research fellow in the Department of Epidemiology, showed a small increased risk of preterm birth and of the pregnancy complication preeclampsia among women taking certain psychostimulants. The researchers also found the non-stimulant ADHD medication atomoxetine did not appear to increase the risk of placental complications, suggesting that non-stimulant drugs may be a safer choice for women who take ADHD medications.

The increases in risk identified do not warrant abstaining from critical treatment, said Cohen in a November 10, 2017 Medscape Medical News article. It is important to balance the benefits of treatment, which may improve functioning, including maintaining family relationships, adherence to prenatal care, and avoidance of substance abuse.

The paper was one of two new studies on the subject discussed in the Medscape article. The other study, by Swedish researchers, was published in the November 2017 Pediatrics. The researchers and others interviewed by Medscape said that more research is needed to fully understand the possible health and safety risks of women taking stimulants during pregnancy.

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Adverse Gestational Outcomes Associated With Attention

Chittaranjan Andrade, MD

ABSTRACT

J Clin Psychiatry 2018 79:18f12136

To cite: Andrade C. Adverse gestational outcomes associated with attention-deficit/hyperactivity disorder medication exposure during pregnancy. J Clin Psychiatry. 2018 79:18f12136.

To share: https://doi.org/10.4088/JCP.18f12136

The use of attention-deficit/hyperactivity disorder medications during pregnancy is increasing. For example, Danish health registry data showed that, between 2003 and 2010, the use of these medications by pregnant women rose from 5 per 100,000 person-years to 533 per 100,000 person-years.1 North American data suggest similar trends one study reported that the use of ADHD medications in pregnancy rose from 0.2% during 1997-1998 to 1.3% during 2013.2

An earlier article in this column3 examined the risk of major congenital malformations following first trimester gestational exposure to psychostimulant medications in summary, there did not seem to be sufficient evidence, at present, to suggest that methylphenidate and amphetamines are teratogenic. The present article examines whether ADHD medications are associated with other adverse gestational outcomes data from 1 large4 and 4 smaller1,5-7 studies are specifically reviewed.

Placental Complications Associated With Early and Late Pregnancy Exposure to ADHD Medications

Findings. Important findings for early gestational exposure are presented in Table 1. In summary:

Other Recent Studies

Critical Comments

REFERENCES

Adderall And Breastfeeding: Can You Use Adhd Stimulants While Nursing

Taking Acetaminophen While Pregnant Linked To ADHD In Kids

There exist no controlled studies on the safety of psychiatric medications of all types in nursing mothers. Thus, as with pregnancy, whether to take ADHD medication while nursing is another decision pregnant women need to make without clear scientific evidence to guide them.

The Lactation Risk Category, developed by Thomas Hale, M.D., is most frequently used by medical professionals, though its not universally accepted. For nursing, ADHD medications are classified as L3: Moderately Safe. This classification indicates that There are no controlled studies in breastfeeding women, however the risk of untoward effects to a breastfed infant is possible. Drugs should be given only if the potential benefit justifies the potential risk to the infant.

Concerning lactation, many health professionals believe that the risks associated with not breastfeeding may outweigh the risks of using stimulants. The American Academy of Pediatrics recommends that women breastfeed their babies for at least one year. Additionally, most doctors advise their pregnant patients to discontinue any inessential medication while pregnant or nursing, as traces of the medication may show up in the mothers milk.

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Adhd Stimulant Medication During Pregnancy

Should a pregnant woman with ADHD take stimulant medication like Ritalin, Adderall XR or Concerta? There is no clear cut answer, but there are risks to the fetus that should be considered.

With more and more women being diagnosed and treated for AD/HD, the question of safe use of stimulant medications during pregnancy has become more critical. In general, stimulants are all considered “Category C” teratogens. That means that they should only be used when the risk to the mother outweighs the risk to the fetus.

To date, the effects of stimulants during pregnancy have only been studied in animals, where defects were seen in the offspring when the mothers were given very high doses of the stimulants. The doses of stimulants given to animals for these studies have been 41x and 12x the usual human dose. The literature contains individual case reports of women who have taken stimulants during their pregnancy and, clinically, there have been many other women who have taken stimulants and have had normal babies.

The important questions for a woman who is being treated for AD/HD and who is thinking about getting pregnant or who recently learned that she is pregnant are the following:

  • Should she discontinue stimulants prior to becoming pregnant?
  • Should she continue stimulants after her first 3 months?
  • Should she discontinue medication during the entire pregnancy?
  • What are the risks both to the mother and the baby if her AD/HD goes untreated?

Source:CHADD website

Adderall While Trying To Get Pregnant

Little information exists about the risks of taking Adderall while trying to conceive. However, a study on methylphenidate a stimulant related to Adderall showed no increased risk of birth defects in women who took the drug during early pregnancy. A study on dextroamphetamine had similar results. It found no impact on the babys weight, head circumference, length or risk of birth defects when the drug was stopped before the 28th week of pregnancy.

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Is There Any Adhd Medications Safe To Use While Pregnant

You may have found websites with lists of ADHD medications deemed safe for use while pregnant, but dont take those lists at face value. While some medications may, in fact, be okay to use, you should never rely on medical advice given by anyone but your own doctor. Your doctor knows you and your current medical conditions better than anyone else. They know what medications youre currently taking, as well as what pregnancy complications you might be going through. With that said, your doctor is the only one who can tell you what is safe for you to take given your current health status.

Can Taking Adderall While Pregnant Cause Birth Defects

Study: Exposure to acetaminophen in pregnancy linked to higher risk of ADHD, autism

The FDA has placed Adderall in Pregnancy Category C because there is a chance it may affect fetal development. While there is weak evidence of birth defects among animal models, one report of birth defects linked to using the medication during pregnancy has been published. Here, a pregnant woman taking dextro-amphetamine sulfate gave birth to a baby with severe bone and throat deformities .

Larger studies dont show a clear link between Adderall and birth defects. Research on thousands of women from the United States and Scandinavian countries suggested that amphetamine could raise the risk of birth defects by 30%. This was an absolute increase from 35 to 45 babies per 1,000 births. When these results were adjusted for factors such as psychiatric disorders, the association disappeared .

However, the studys criteria only required at least one prescription in the first three months of pregnancy, and only looked at live births. Miscarriages and Adderall abuse were therefore overlooked, so it may not be relevant if you use Adderall as a study pill.

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Gathering Data And Making Decisions

When I spoke to Oster again recently, she explained that making good decisions depends a lot on asking the right question. Rather than asking how committed to breastfeeding I was, she said, a better question to ask myself would have been What are my actual options? With all the options on the table, you then go about gathering data. When I talk about fact-finding, she explained, particularly in these places where its a data-poor environment, you want to collect all of the information. That includes what we know about breastfeeding in general, my experiences with and without medication, my priorities and my personal risk tolerance.

In the absence of clinical trial data, Kellams urges doctors to consult resources like LactMed, the drugs and lactation database, and the reference manual Hales Medications & Mothers Milk, both of which compile the most recent anecdotal and case-based published reports on medication safety and lactation. Everyone deserves to get all of that information, Kellams says, so they can arrive at the plan thats best for them.

In the end, prioritizing my own mental health wasnt selfish it was the best parenting decision Ive ever made. Not because it was the right thing to do, or even the only thing to do, but because it was absolutely the right choice for my family.

Have a question about parenting? Ask The Post.

How Long Does Adderall Stay In Breastmilk

The amount of time that Adderall lasts in your breastmilk will depend on how much Adderall you use. Unless it is heavily misused, the amounts of Adderall present in breastmilk will normally be negligible within 48 hours. Adderall may still be detectable after this point, but its impact will be minimal.

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Does Pregnancy Affect Cognitive Function

You may be pleasantly surprised to learn that baby brain isnt unequivocally evidence-based, especially if youve struggled to focus under normal circumstances. Therefore, using more stimulant medication during pregnancy is not necessary.

Self-reported studies suggest issues including poor attention span, memory impairment, trouble reading, confusion, and lack of coordination. However, memory and executive function tests still showed that average scores were within the normal range, even if there was some impairment.

There is also mixed evidence for pregnancys impact on the development of new brain cells. Some research suggests slowed growth of new brain cells in the hippocampus , others report an increase, and some have found no change.

It is possible that baby brain is at least partially the result of stress and an unfamiliar, busier lifestyle, too .

Use Of Adhd Medicine Is Increasing Among Pregnant Women

Link Between ADHD Medication &  Pregnancy

A study from the Centers for Disease Control and Prevention found that an increasing number of pregnant women are taking attention-deficit/hyperactivity disorder medicine. The study also found that women who took ADHD medicine during early pregnancy may be more likely to have a baby with some types of birth defects compared to women who did not take ADHD medicine. This is among the first few studies to look at ADHD medicine use among pregnant women and risk for individual birth defects. More research is needed to determine the safest treatment options for managing symptoms of ADHD during pregnancy.

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Risks To Developing Baby

Truth be told, scientists dont know as much as you might expect about Adderalls exact effects on pregnant mothers and their growing babies.

Heres the thing: Its tricky to do research on exactly how medications affect babies in utero. No one wants to conduct studies based on exposing pregnant women to potentially harmful drugs. This is why most studies on Adderall and pregnancy have been done on animals.

That said, according to the Center for Disease Control , animal studies show that Adderall may increase the risk of congenital abnormalities involving the limbs or digestive tract.

Dr. Ross notes that there are other uncertainties to consider, too. Babies born to mothers taking Adderall in pregnancy are at increased risk of premature delivery, low birth weight, and withdrawal symptoms including agitation, dysphoria, laziness, and poor feeding and growth.

On the plus side, a

Adhd Medications In Pregnancy And Neonatal Outcomes

Analyzing data from the Swedish Medical Birth Register, the Prescribed Drug Register, and the Swedish Neonatal Quality Register, researchers compared infants exposed to ADHD medication during pregnancy with infants whose mothers never used these drugs and infants whose mothers used ADHD medication before or after pregnancy. Out of 964,734 infants included in the analysis, 1,591 were exposed to ADHD medication during pregnancy.

Exposure to ADHD medications during pregnancy increased the risk for NICU admission, as compared to no maternal use or to use before or after pregnancy . Looking at specific outcomes, infants exposed during pregnancy were more likely to have central nervous system-related disorders and were more often moderately preterm than non-exposed infants.

There was no increased risk for congenital malformations or perinatal death.

These findings are consistent with previous studies which have demonstrated an increased risk of perinatal complications in infants exposed to stimulants during pregnancy. However, what makes this study more useful and clinically relevant is that it focuses on exposure to stimulants prescribed in standard doses, as opposed to previous studies which studied outcomes primarily in women who were abusing or misusing stimulants in combination with other substances.

Ruta Nonacs, MD PhD

Nörby U, Winbladh B, Källén K. Perinatal Outcomes After Treatment With ADHD Medication During Pregnancy. Pediatrics. 2017 Dec 140.

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Potential Risks Of Taking Adderall While Pregnant

Many concerns about taking Adderall while pregnant have to do with a potential impact on the babys growth and premature delivery. One common side effect of Adderall is a , which may lead to growth problems with the baby. Additionally, a recent study observed a small but significant increase of certain birth defects in women taking stimulants while pregnant. Specifically, the study showed an increased risk of:

  • Gastroschisis: The baby is born with its intestines outside the body, but this can be fixed with surgery.
  • Omphalocele: The baby is born with part of its abdomen outside the body, but this can be repaired with surgery.
  • Transverse limb deficiency: Part of a babys limb is smaller than expected or missing.

Routine prenatal care is important for any pregnant woman, especially if they are taking a medication like Adderall. Prenatal exams tell the doctor whether the baby is growing at an appropriate rate while the mother is taking Adderall. Further, ultrasound exams may help the doctor find out if there are certain birth defects.

Is Vyvanse Safe To Take While Breastfeeding

HealthWatch: Acetaminophen And Pregnancy

It does cross over through breast milk, says Danielle Plummer, Pharm.D., founder of HG Pharmacist. The baby is then potentially going to go through withdrawal when you wean them from nursing. Caregivers should carefully watch babies born to or breastfed by mothers taking Vyvanse for withdrawal symptoms like trouble feeding, irritability, distress, and extreme drowsiness. Some experts recommend that women avoid breastfeeding while using this medication.

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I Took Adderall Before I Knew I Was Pregnant: What Now

If you have recently learned that you are pregnant and have been taking Adderall, its important to avoid going cold turkey. Abruptly stopping the drug leads to a sharp fall in dopamine and noradrenaline, as your body has established Adderall tolerance.

Going cold turkey leads to the infamous Adderall crash, which features symptoms including depression, fatigue, and insomnia. In the worst cases, mental health can decline with the development of psychosis and suicidal thoughts, putting you and your baby at even greater risk of harm .

Answers To Questions About Ritalin Vyvanse Adderall And Pregnancy

The decision to continue ADHD medications during pregnancy is ideally made when the patient informs her physician that she plans to start a family, when there is time to do research and make the best decision. But life does not always go as planned: the C.D.C reports that around half of all U.S. pregnancies are unintended and this number may be even higher among women with ADHD.4 Frequently, the medication decision is first discussed after the woman learns that she is pregnant, often four or more weeks into the pregnancy, after the fetus has already been exposed to medications.

Most studies regarding amphetamine or methylphenidate use during pregnancy come from drug abuse studies. Thus, the results of these studies may not be applicable to women with ADHD who rely on amphetamine medications, such as Adderall or Vyvanse, or methylphenidate medications, such as Concerta or Ritalin, to manage their symptoms. However, the serious negative outcomes of these studies such as higher infant mortality rates, preterm deliveries, and lower ratings on the Apgar scale cause many clinicians to take caution when advising their patients about continuing ADHD medication in pregnancy.5

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