ADHD, or attention-deficit/hyperactivity disorder has become one of the most commonly diagnosed neurodevelopmental disorders of childhood, and the number of people on medication for ADHD has increased dramatically. According to the CDC, 6.1 million (9.4%) of children between the ages of 2 through 17 have been diagnosed with ADHD. Two thirds of these children are taking medication. 4% of adults have been diagnosed with ADHD and this number has increased steadily over the last couple of years. Currently the number of women with ADHD on medications is small. About 1 in 100 women took ADHD medication during pregnancy. This number will likely increase dramatically as so many more adults carry the diagnosis.
Medications taken for ADHD include the following: Adderall, Concerta, Vyvanse, Ritalin, Focalin, Dexedrine, Metadate to name a few. These medications are stimulants and can be short acting, intermediate or long acting. The side effects of these medications include loss of appetite, weight loss, sleep problems, tics, heart palpitations, or worsening of anxiety or depression.
Is my baby at higher risk of birth defects if I take medication for ADHD? The answer to this is, unfortunately, yes. ADHD medication in early pregnancy may be related to the following birth defects: gastroschisis (a condition where the baby’s intestine develop outside the baby’s body), omphalocele (a condition where the intestine of other abdominal organs are outside of the body), and transverse limb deficiency (where all or part of an arm/hand or leg/foot don’t develop). A study performed by the CDC found that women who took ADHD medicine during early pregnancy were at a higher risk of having a baby with certain birth defects compared to women who did not take ADHD medication. Since the overall risk of birth defects is very low, data from this study was based on small numbers and so the literature on ADHD medication during pregnancy is very limited.
In addition to this, there is an increased risk of low birth weight, prematurity, preeclampsia and increased morbidity because of increased placental vasoconstriction (when the blood vessels contract and don’t deliver blood effectively). There can also be symptoms neonatal withdrawal.
So, what should I do? Unfortunately, we don’t have a great reservoir of information on the topic because the data is limited. The data is even further limited to determining long term behavioral and learning effects to children who were exposed to stimulants in utero. For these reasons, we encourage women with mild to moderate ADHD symptoms to consider discontinuing medication and switch to behavioral therapy while pregnant or even before conceiving if possible.
For patients with severe ADHD, this decision would likely be made on a case by case basis in conjunction with their psychiatrist. If you are pregnant or trying to conceive and currently taking medication for ADHD, please have a detailed discussion with your provider prior to continuing (or discontinuing) the medication while pregnant or attempting pregnancy.