From the Guidelines
It is not recommended to take Adderall during pregnancy unless the benefits clearly outweigh the risks, and a thorough risk-benefit discussion with healthcare providers is necessary to determine the best course of action. According to the most recent study published in the American Journal of Obstetrics and Gynecology in 2024 1, stimulant medications, including amphetamine-based stimulants like Adderall, are typically the first choice to treat ADHD because they work for 70% to 80% of people with ADHD. However, 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.
When considering the use of Adderall during pregnancy, it is essential to weigh the risks of exposure to the medication against the risks of untreated or inadequately treated ADHD in pregnancy. The study suggests that methylphenidate, dextroamphetamine, and atomoxetine have all been shown to cross the placenta in rat and mice models, and it is generally thought that the medications used to treat ADHD cross the placenta in humans, leading to exposure to the developing fetus 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, emphasizing the importance of a risk-benefit discussion and careful monitoring of pregnancy.
Key considerations for ADHD medication management during pregnancy include:
- Engaging the patient in a risk-benefit discussion regarding the choice of medication and lowest effective dose
- Considering a trial of gradually discontinuing the medication before pregnancy if it is not likely to severely impact daily functioning
- Continuing with the current medication or reducing to the lowest effective dose or considering intermittent use or switching to a nonstimulant option
- Monitoring pregnancy carefully, including fetal growth, blood pressure checks, and ensuring appropriate weight gain 1
In some cases, where ADHD symptoms are severe and significantly impact daily functioning, healthcare providers might determine that continuing a reduced dose of Adderall is necessary. Non-medication approaches such as behavioral therapy, counseling, and support strategies should also be considered as part of the treatment plan during pregnancy. Ultimately, any medication changes should be discussed with healthcare providers rather than stopping medications abruptly on their own.
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. Embryotoxic effects were not seen in New Zealand white rabbits given the drug in doses 7 times the human dose nor in rats given 12. 5 times the maximum human dose. While there are no adequate and well-controlled studies in pregnant women, there has been one report of severe congenital bony deformity, tracheoesophageal fistula, and anal atresia (Vater association) in a baby born to a woman who took dextroamphetamine sulfate with lovastatin during the first trimester of pregnancy Dextroamphetamine should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.
Key Points:
- Dextroamphetamine has shown embryotoxic and teratogenic effects in animal studies.
- There are no adequate and well-controlled studies in pregnant women.
- Dextroamphetamine should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. It is not safe to take Adderall (amphetamine and dextroamphetamine) during pregnancy without careful consideration of the potential risks and benefits, as determined by a physician 2.
From the Research
Safety of Adderall During Pregnancy
- The safety of Adderall (amphetamine and dextroamphetamine) during pregnancy is a concern, as it may increase the risk of premature birth, low birth weight, and other pregnancy complications 3.
- A systematic review and meta-analysis found that exposure to ADHD medication, including amphetamines, 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.
- The data on the effects of stimulants, including amphetamines, in pregnancy are generally reassuring, but methylphenidate might be preferred over amphetamines due to the possibility of breastfeeding 3.
- There is limited information on the long-term neurodevelopmental effects of ADHD medications, including amphetamines, on children born to mothers who took these medications during pregnancy 3, 4.
Comparison with Other Medications
- Methylphenidate, another ADHD medication, may slightly increase the rate of cardiac malformations and spontaneous abortions, but is considered safer than amphetamines during pregnancy 3.
- Bupropion, a non-stimulant medication, appears to be safe in pregnancy and may be a preferred alternative to stimulants 3.
- Other medications, such as benzodiazepines, have been associated with preterm delivery and low birth weight, and should be used with caution during pregnancy 5.