Is it safe to continue taking Abilify (aripiprazole) and Vyvanse (lisdexamfetamine) during pregnancy?

Continuation of Abilify and Vyvanse During Pregnancy

Both medications can be continued during pregnancy when the functional impairment from untreated mental illness significantly impacts maternal wellbeing, though each carries distinct risks that require careful monitoring and informed decision-making.

Vyvanse (Lisdexamfetamine) in Pregnancy

Safety Profile

• Amphetamines, including lisdexamfetamine, cross the placental barrier but do not appear to be associated with major congenital malformations, including cardiac defects 1
• The FDA label advises patients to notify their healthcare provider if they become pregnant or intend to become pregnant during treatment 2

Specific Risks to Monitor

• Small increased risk of gastroschisis (adjusted odds ratio 3.0; 95% CI, 1.2-7.4) 1
• Preeclampsia risk (adjusted relative risk 1.29; 95% CI, 1.11-1.49) 1
• Preterm birth if continued in the second half of pregnancy (adjusted relative risk 1.30; 95% CI, 1.10-1.55) 1
• Possible increased risk for spontaneous abortion, though confounding by indication cannot be ruled out 1

Neonatal Monitoring

• Monitor infants carefully for irritability, insomnia, and feeding difficulties after delivery 1

Alternative Approach

• The American College of Obstetricians and Gynecologists recommends considering non-pharmacological interventions for ADHD during pregnancy 1

Abilify (Aripiprazole) in Pregnancy

Safety Profile

• Neonates exposed during the third trimester are at risk for extrapyramidal and/or withdrawal symptoms following delivery, including agitation, hypertonia, hypotonia, tremor, somnolence, respiratory distress, and feeding disorder 3
• Overall available data from published epidemiologic studies have not established a drug-associated risk of major birth defects or miscarriage 3
• A retrospective Medicaid database study of 9,258 women exposed to antipsychotics during pregnancy did not indicate an overall increased risk for major birth defects 3

Specific Pregnancy Complications

• One retrospective study found aripiprazole use was associated with increased risk of pregnancy hypertension, lower birth weight, shorter gestation at birth, and higher rates of neonatal admission 4
• However, aripiprazole was not associated with an increased risk of gestational diabetes 4

Neonatal Management

• Monitor neonates for extrapyramidal and/or withdrawal symptoms 3
• Some neonates recover within hours or days without specific treatment; others require prolonged hospitalization 3

Important Maternal Consideration

• Lactation failure has been reported in multiple case reports after delivery in women taking aripiprazole 5, 6

Risk of Untreated Mental Illness

Maternal Risks

• Untreated schizophrenia carries increased risk of relapse, hospitalization, and suicide 3
• Schizophrenia is associated with increased adverse perinatal outcomes, including preterm birth 3
• A prospective study of 201 pregnant women with major depressive disorder found that women who discontinued antidepressants during pregnancy were more likely to experience relapse 3

Clinical Decision Algorithm

Continue both medications if:

• The functional impairment from untreated illness significantly impacts maternal safety and wellbeing
• The patient understands the specific risks outlined above
• Close monitoring can be implemented throughout pregnancy

For Vyvanse specifically:

• Obtain baseline blood pressure and monitor for preeclampsia throughout pregnancy 1
• Perform detailed anatomic ultrasound at 18-20 weeks to assess for gastroschisis 1
• Consider discontinuation in second half of pregnancy if ADHD symptoms are manageable, to reduce preterm birth risk 1

For Abilify specifically:

• Monitor blood pressure for pregnancy-induced hypertension 4
• Arrange for neonatal monitoring team to be present at delivery if continued through third trimester 3
• Counsel patient about potential lactation failure 5, 6

Common Pitfall to Avoid

Do not automatically discontinue these medications based solely on pregnancy status without weighing the substantial risks of untreated mental illness, which can include maternal suicide, inability to engage in prenatal care, and poor pregnancy outcomes from the underlying psychiatric condition itself 3.