From the Guidelines
It is crucial to consult with your obstetrician and the healthcare provider who prescribed your Adderall to determine the safest course of action for continuing 20mg XR Adderall during pregnancy. According to the most recent study published in the American Journal of Obstetrics and Gynecology in 2024 1, stimulant medications like Adderall are typically the first choice to treat ADHD because they work for 70% to 80% of people with ADHD. However, the study also notes that discontinuing psychostimulant treatment during pregnancy can lead to worse mental health outcomes and significant impairments in functioning in the pregnant individual, which may subsequently have negative impacts on the developing fetus or baby.
The study suggests that the risks of exposure to medications to treat ADHD in pregnancy should be weighed against the risks of untreated or inadequately treated ADHD in pregnancy 1. Another study published in the same journal in 2024 1 provides general principles regarding ADHD medication management for women and gender diverse birthing individuals during pregnancy and while breastfeeding, including considering a trial of gradually discontinuing the medication before pregnancy if it is not likely to severely impact daily functioning.
A third study published in the same journal in 2024 1 provides information on the fetal or neonatal risk and breastfeeding risk associated with amphetamine mixed salts (Adderall XR), including a possible increased risk for gastroschisis and preeclampsia, as well as a possible increased risk for preterm birth when stimulant use continues in the second half of pregnancy. The decision to continue or discontinue Adderall during pregnancy should be made on a case-by-case basis, taking into account the individual's specific medical needs and the potential risks and benefits of treatment. Your healthcare providers may recommend gradually tapering the dose, switching to a different medication considered safer in pregnancy, or implementing non-medication strategies to manage your symptoms, as part of your comprehensive prenatal care plan 1.
From the FDA Drug Label
Dextroamphetamine has been shown to have embryotoxic and teratogenic effects when administered to A/Jax mice and C57BL mice in doses approximately 41 times the maximum human dose. Dextroamphetamine should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Infants born to mothers dependent on amphetamines have an increased risk of premature delivery and low birth weight.
It is not safe to stay on 20xr Adderall while pregnant without careful consideration of the potential risks. The use of dextroamphetamine during pregnancy is associated with an increased risk of embryotoxic and teratogenic effects, as well as premature delivery and low birth weight. The decision to continue using Adderall should be made by a physician, weighing the potential benefits against the potential risks to the fetus 2.
From the Research
Safety of Adderall During Pregnancy
- The safety of Adderall, which contains amphetamines, during pregnancy is a concern due to potential risks to the fetus 3, 4, 5.
- Studies have shown that stimulant use during pregnancy may be associated with a small increased relative risk of preeclampsia and preterm birth 4.
- However, the absolute increases in risks are small, and women with significant ADHD should not be counseled to suspend their ADHD treatment based on these findings 4.
- Another study found that amphetamine/dextroamphetamine exposure in utero was not likely to meaningfully increase the risk of childhood neurodevelopmental disorders 6.
- Methylphenidate exposure was associated with an increased risk of ADHD, but not other outcomes, after adjustment for confounders 6.
Potential Risks to the Fetus
- Prenatal exposure to amphetamines has been linked to an increased risk of clefting, cardiac anomalies, and fetal growth reduction deficits 5.
- Methamphetamine abuse during pregnancy has been associated with an increased risk of preeclampsia, hypertension, fetal demise, preterm delivery, and intrauterine growth restriction 7.
- The deleterious effects of prenatal methamphetamine exposure on the developing fetal brain may lead to long-term neuro-developmental and behavioral problems 7.
Recommendations for Pregnant Women Taking Adderall
- Pregnant women taking Adderall should be closely monitored by their healthcare provider to minimize potential risks to the fetus 3, 4.
- The decision to continue or discontinue Adderall during pregnancy should be made on a case-by-case basis, taking into account the individual woman's medical history and the potential benefits and risks of treatment 3, 4.