Can Adderall (amphetamine and dextroamphetamine) cause miscarriage?

Adderall and Miscarriage Risk

Adderall (amphetamine and dextroamphetamine) may be associated with a possible increased risk of spontaneous abortion during pregnancy, though the evidence is limited and confounding factors cannot be ruled out.

Risk of Miscarriage

• Amphetamines, including Adderall, have been associated with a possible increased risk for spontaneous abortion, though confounding by indication cannot be ruled out 1
• The FDA classifies dextroamphetamine (a component of Adderall) as Pregnancy Category C, indicating that potential benefits may warrant use despite potential risks 2
• Limited published information exists specifically on amphetamine use during pregnancy and its direct causal relationship to miscarriage 1

Other Pregnancy Risks

• Amphetamines cross the placental barrier and may affect the developing fetus 3
• Dextroamphetamine has shown embryotoxic and teratogenic effects in animal studies at doses approximately 41 times the maximum human dose 2
• Infants born to mothers dependent on amphetamines have an increased risk of:
  • Premature delivery 2
  • Low birth weight 2
  • Withdrawal symptoms including agitation and lassitude 2

Potential Complications Beyond Miscarriage

• Possible increased risk for preeclampsia (adjusted relative risk 1.29; 95% CI, 1.11-1.49) with amphetamine exposure during pregnancy 3, 4
• Possible increased risk for preterm birth (adjusted odds ratio 1.3; 95% CI, 1.1-1.6) with continued stimulant use in the second half of pregnancy 3, 4
• Possible increased risk for gastroschisis (adjusted odds ratio 3.0; 95% CI, 1.2-7.4), though this risk appears to be small given the rarity of the condition 3

Clinical Considerations

• Amphetamines do not appear to be associated with major congenital malformations or significant adverse developmental outcomes when used therapeutically 3, 5
• Monitor infants carefully for irritability, insomnia, and feeding difficulties if the mother was taking amphetamines during pregnancy 3
• The risk information provided applies to therapeutic use and does not apply to non-prescribed amphetamine use in persons with stimulant use disorder 3

Decision-Making Algorithm

1. Assess the severity of ADHD symptoms and their impact on daily functioning
2. Consider non-pharmacological interventions for ADHD during pregnancy
3. If medication is deemed necessary:
   • Discuss the possible increased risk of spontaneous abortion and other pregnancy complications 1, 4
   • Weigh benefits of treatment against potential risks to both mother and fetus 6
   • Consider that discontinuing ADHD treatment could also put both mother and baby at risk due to untreated symptoms 6

Important Caveats

• Most studies on ADHD medications in pregnancy have substantial methodological differences and inadequate adjustment for confounding factors 7
• None of the included studies in systematic reviews adjusted for ADHD severity in the mothers, which is a significant limitation 7
• The absolute risks of adverse outcomes appear to be small in magnitude even when relative risks are elevated 7