Is Adderall (amphetamine and dextroamphetamine) safe to use during pregnancy?

From the Guidelines

Adderall (amphetamine and dextroamphetamine) should be used with caution during pregnancy, as the potential benefits must be carefully weighed against the potential risks to the developing fetus. According to the most recent study published in the American Journal of Obstetrics and Gynecology in 2024 1, amphetamine mixed salts (Adderall XR) do not seem to be associated with major congenital malformations, but there may be a possible increased risk for gastroschisis, preeclampsia, and preterm birth.

Key Considerations

• The study suggests that the risks of exposure to medications for ADHD in pregnancy should be weighed against the risks of untreated or inadequately treated ADHD in pregnancy 1.
• Discontinuing psychostimulant treatment during pregnancy can lead to worse mental health outcomes and significant impairments in functioning in the pregnant individual, which may have negative impacts on the developing fetus or baby 1.
• For women with ADHD who become pregnant, healthcare providers typically recommend exploring non-medication alternatives such as behavioral therapy, counseling, and support systems 1.
• If medication is deemed necessary, the doctor will carefully weigh the risks and benefits to determine the safest approach for both the mother and the baby 1.

Recommendations

• Pregnant women should avoid Adderall unless the potential benefit justifies the potential risk to the fetus.
• If currently taking Adderall and discovering pregnancy, do not stop taking it abruptly; instead, consult the healthcare provider immediately to discuss the specific situation.
• Potential risks associated with Adderall use during pregnancy include premature birth, low birth weight, withdrawal symptoms in the newborn, and potential developmental issues.
• Always discuss any medication use with the obstetrician and the prescribing physician before and during pregnancy 1.

From the FDA Drug Label

Pregnancy Teratogenic Effects Pregnancy Category C 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.

Adderall is not recommended for use during pregnancy unless the potential benefit outweighs the potential risk to the fetus. The drug label indicates that dextroamphetamine, a component of Adderall, has been shown to have embryotoxic and teratogenic effects in animal studies. Additionally, there is a reported case of severe congenital bony deformity in a baby born to a woman who took dextroamphetamine sulfate during the first trimester of pregnancy 2. Infants born to mothers dependent on amphetamines are also at increased risk of premature delivery and low birth weight, and may experience symptoms of withdrawal.

From the Research

Adderall Use in Pregnancy

• The use of Adderall (amphetamine and dextroamphetamine) during pregnancy is a concern due to the potential risks to the fetus and the lack of sufficient information on its safety 3, 4.
• The US Food and Drug Administration has classified ADHD medications, including Adderall, as "pregnancy category C", implying that there is insufficient information to confirm either harm or lack of harm 3, 5.
• Studies have shown that the risk of fetal malformation associated with ADHD medication use during pregnancy is low, but the data are limited and more research is needed to fully understand the potential risks 4, 6.

Potential Risks and Benefits

• The use of Adderall during pregnancy may be associated with an increased risk of cardiac malformations, particularly ventricular septal defects 6.
• However, the absolute risk of malformations overall is low, and the benefits of treating ADHD during pregnancy may outweigh the potential risks for some women 3, 4.
• Discontinuing ADHD treatment during pregnancy may also pose risks to both the mother and the fetus, highlighting the need for careful consideration and consultation with a healthcare provider 3, 4.

Guidance for Healthcare Providers

• Healthcare providers should consider the individual circumstances of each woman and weigh the potential benefits and risks of Adderall use during pregnancy 4.
• Pregnant women should be informed of the potential risks and benefits of Adderall use and involved in the decision-making process 3, 4.
• More research is needed to fully understand the safety of Adderall use during pregnancy and to provide evidence-based guidance for healthcare providers 4, 6.