The use of medication for attention deficit hyperactivity disorder (ADHD) during pregnancy more than doubled between 1998 and 2011. With many adults of child-bearing age being treated for ADHD, it is important to know the risks and benefits of taking these medications during pregnancy so that expectant mothers, along with their healthcare providers, can make informed decisions about their treatment options.
Adderall is one of the medications used for treating ADHD and is also used to treat narcolepsy. It is a stimulant that contains the drugs amphetamine and dextroamphetamine. Because of its proven effectiveness at improving the symptoms associated with ADHD such as inattention, difficulty focusing, and impulsive behavior, Adderall is considered a first-choice treatment option for ADHD. But, do Adderall and pregnancy mix?
Is it safe to take Adderall during pregnancy?
“According to the Federal Drug Administration (FDA), there is no clear-cut decision on [whether Adderall is safe during pregnancy] as Adderall and other stimulants are not proven to be safe nor are they proven to be harmful either,” says Makaela Premont, Pharm.D., a pharmacist in North Carolina. “As a result, the decision is based on the patient and the physician’s clinical decision to determine if the benefits outweigh the risks for the patient and fetus.”
In 2015, the FDA replaced its 5-letter classification system for the safety of medications during pregnancy with one that emphasizes pertinent information for each individual medication on pregnancy and lactation.
In the previous system, Adderall was considered a Class C, meaning it is potentially harmful, based on animal studies, but there are no available human studies from which to make a determination of safety for human babies. The few human studies that do exist mainly focus on drug abuse and may not be applicable to prescribed use of Adderall and other stimulants during pregnancy.
In one study, early pregnancy ADHD medication use was more commonly reported by mothers of infants/fetuses with gastroschisis (the baby’s intestines are outside of the baby’s body at birth), omphalocele (the baby’s intestines, liver, or other organs stick outside of the belly through the belly button at birth), and transverse limb deficiency (a congenital anomaly that resembles an amputation of an arm, leg or finger/toe). “Most of the concerns about taking Adderall while pregnant have to do with the impact on the baby’s growth, development, and premature delivery,” Dr. Premont says.
A systematic review and meta-analysis conducted in 2018 suggested that exposure to ADHD medication during pregnancy does not appear to be associated with adverse maternal or neonatal outcomes, but more studies are needed to verify these findings as there are few current studies and most are not controlled for other variables.
Babies born to parents who took amphetamines during pregnancy should be monitored for symptoms of withdrawal such as feeding difficulties, irritability, agitation, and excessive drowsiness.
Because there is no available data on the long-term effects of the use of Adderall during pregnancy, it is important that women and their healthcare providers consider if the benefits of its use outweigh the risks.
Recommended dosages for Adderall are the same in pregnant and non-pregnant patients, but may be adjusted if the patient and their healthcare provider deem it necessary or preferable. “Once a patient finds out that they are pregnant, it is best to tell their healthcare provider right away so a decision can be made,” says Dr. Premont. “The doctor will educate and provide the patients with options that they find fit for their individualized needs.”
Can Adderall make it harder to get pregnant?
No controlled studies exist that measure whether Adderall and other stimulants affect fertility in humans, but their use does not appear to impair fertility in people. An analysis of animal studies did show an impairment of fertility in animals, but the studies were generally of poor quality or poorly reported.
Should you stop taking Adderall when you find out you’re pregnant?
No, you should not immediately change your medication regimen. “If the patient and doctor determine that risks [of taking Adderall while pregnant] outweigh the benefit, it is best to taper down slowly, opposed to stopping abruptly, to avoid or decrease withdrawal symptoms,” says Danielle Plummer, Pharm.D., a pharmacist in Las Vegas. “Talk to both your doctor who confirmed the pregnancy and the doctor who prescribed Adderall to decide the best course of action. It is not recommended to stop taking Adderall right away.”
Is it safe to take Adderall while breastfeeding?
As with pregnancy, there is little data on whether or not it is safe to breastfeed while taking Adderall. “The biggest concerns that healthcare providers have about taking Adderall while breastfeeding is that the drug can pass through the breast milk and cause undesirable symptoms such as decreased milk production for mom and restlessness, insomnia, failure to thrive, and loss of appetite in babies,” says Dr. Premont.
Available studies suggest that although medication for ADHD does transfer into breast milk, the risk for adverse outcomes in breastfed infants is minimal if the ADHD medication is taken as prescribed, though long-term effects have not been adequately studied.
“With conflicting responses, please discuss the risks versus benefits with your doctor and a lactation consultant,” says Dr. Plummer. “If the new mom decides to stop taking Adderall while breastfeeding, determine a plan to taper down the medication prior to delivery.”
Which stimulants are safe during pregnancy and nursing?
“All stimulants have a risk of causing complications during pregnancy and should not be started during pregnancy,” says Dr. Plummer. “Any woman who is taking stimulants prior to becoming pregnant should discuss the risks of continuing the medication during pregnancy with her doctor.”
The current recommendation is that pregnant women and women planning to become pregnant should discuss the benefits versus risks of taking stimulants or any medications while pregnant or breastfeeding and determine a plan best suited to their individual needs.
To help researchers gain more knowledge on the subject, all pregnant women taking stimulants are encouraged to enroll in the National Pregnancy Registry for Psychostimulants where these risks are being monitored.