From the Guidelines
Adderall should not be discontinued during pregnancy without careful consideration of the potential risks and benefits, as discontinuing psychostimulant treatment 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 1. When considering the management of ADHD during pregnancy, it is essential to weigh the risks of exposure to medications against the risks of untreated or inadequately treated ADHD 1. Key points to consider:
- Stimulant medications, such as Adderall, are typically the first choice to treat ADHD because they work for 70% to 80% of people with ADHD and have been shown to be more effective than nonstimulant medications 1.
- Discontinuing psychostimulant treatment during pregnancy can lead to worse mental health outcomes and significant impairments in functioning in the pregnant individual 1.
- Untreated ADHD has been shown to be associated with increased risks for spontaneous abortion and preterm birth 1.
- If discontinuation is recommended, it is crucial to taper off gradually under doctor's guidance to avoid withdrawal symptoms and consider non-pharmacological treatments for ADHD during pregnancy, such as behavioral therapy and lifestyle modifications 1.
- An individualized treatment plan should be developed to optimize maternal mental health in the perinatal period, including education about the signs and symptoms of deteriorating mental health and strategies for supporting mental wellness 1.
From the Research
Discontinuing Adderall During Pregnancy
- The decision to discontinue Adderall (amphetamine and dextroamphetamine) during pregnancy should be based on the potential risks and benefits of treatment, as there is limited information available on the effects of ADHD medication on the fetus and newborn 2.
- Studies have shown that discontinuing ADHD treatment could put both mother and baby at risk, and that the risk of fetal malformation with methylphenidate is very low 2.
- Amphetamine exposure during early pregnancy has been associated with an increased risk of preeclampsia, but not with other adverse outcomes such as placental abruption, small for gestational age, or preterm birth 3.
- A systematic review and meta-analysis found that exposure to ADHD medication during pregnancy was associated with an increased risk of neonatal intensive care unit (NICU) admission, but not with other adverse maternal or neonatal outcomes 4.
- Another study found that psychostimulant use during pregnancy was associated with a small increased relative risk of preeclampsia and preterm birth, but the absolute increases in risks are small 5.
Considerations for Discontinuation
- The US Food and Drug Administration has classified ADHD medications as being "pregnancy category C", implying that there is insufficient information to confirm either harm or lack of harm 2.
- Women with significant ADHD should not be counseled to suspend their ADHD treatment based on the findings of increased risk of preeclampsia and preterm birth 5.
- The benefits of ADHD medication should be weighed against the potential gestational risks when deciding whether or not to continue treatment during pregnancy 3.
- Discussions about ADHD treatment with women of childbearing age should be balanced, open, and honest, acknowledging the lack of information on the possible risks to the offspring of continuing treatment, while also drawing attention to the possible risks to both mother and child of discontinuing treatment 2.