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

Adderall Use During Pregnancy

Adderall (amphetamine and dextroamphetamine) should not be used during pregnancy unless the potential benefit clearly justifies the potential risk to the fetus, as it is classified as FDA Pregnancy Category C with evidence of embryotoxic and teratogenic effects in animal studies.

Safety Concerns and Risks

Adderall use during pregnancy presents several important safety concerns:

• The FDA has classified amphetamines as "Pregnancy Category C," indicating insufficient information to confirm either harm or lack of harm 1
• Dextroamphetamine has shown embryotoxic and teratogenic effects in animal studies at doses approximately 41 times the maximum human dose 1
• Recent evidence indicates a small but significant increased risk for:
  • Major malformations (OR 1.26,95% CI 1.05-1.51)
  • Cardiac malformations (OR 1.59,95% CI 1.02-2.49) 2
• Continuing stimulant use in the latter half of pregnancy is associated with:
  • Increased risk of preeclampsia (adjusted RR 1.29,95% CI 1.11-1.49)
  • Higher rates of preterm birth (adjusted RR 1.30,95% CI 1.10-1.55) 3
• Infants born to mothers dependent on amphetamines have increased risk of:
  • Premature delivery
  • Low birth weight
  • Withdrawal symptoms including agitation and significant lassitude 1

Decision-Making Framework

When considering ADHD treatment during pregnancy, the American Journal of Obstetrics and Gynecology recommends weighing the risks of medication against the risks of untreated ADHD 4:

1. Pre-pregnancy planning is strongly encouraged for women with ADHD 4
2. Develop an individualized treatment plan that optimizes mental health during pregnancy 4
3. Consider non-pharmacologic treatments first for mild to moderate ADHD:
   • Cognitive Behavioral Therapy (CBT)
   • Self-management strategies
   • Mindfulness-based interventions 4
4. Consider referral to a specialist reproductive psychiatrist for support with medication management during pregnancy 4

Alternative Management Options

For pregnant women with ADHD who require treatment:

• Non-pharmacologic approaches should be prioritized when possible:

  • CBT has been shown to be the most effective non-medication option 4
  • Self-management strategies and coaching
  • Mindfulness-based interventions
  • Dialectical Behavior Therapy (DBT)

• If medication is deemed necessary, the treating physician should:

  • Carefully reconsider the need for treatment during pregnancy 5
  • Consider fetal echocardiography if methylphenidate is used during pregnancy 2
  • Monitor closely for potential complications including preeclampsia, placental abruption, and preterm birth 3

Breastfeeding Considerations

• Amphetamines are excreted in human milk 1
• Mothers taking amphetamines should be advised to refrain from nursing 1
• Limited data show that concentrations of methylphenidate in infant's blood are very low, but amphetamines are contraindicated during breastfeeding 5

Important Caveats

1. Discontinuation risks: Ceasing dexamphetamine during pregnancy has been associated with increased odds of threatened abortion compared to continuing treatment 6

2. Absolute risk perspective: While relative risks are increased with stimulant use, the absolute increases in risks are small. Women with significant ADHD should not automatically suspend treatment based solely on these findings 3

3. Limited evidence: There is a notable lack of data on long-term neurodevelopmental effects of ADHD medications on children exposed during pregnancy 5

4. Individualized assessment: The decision to use Adderall during pregnancy should involve careful consideration of the severity of the woman's ADHD symptoms and the potential impact of untreated symptoms on maternal and fetal well-being 4

In conclusion, while the available safety data for ADHD medications in pregnancy is limited, there are documented risks associated with Adderall use during pregnancy. Non-pharmacological treatments should be prioritized whenever possible, and medication should only be considered when the benefits clearly outweigh the potential risks.