Vyvanse (Lisdexamfetamine) Use During Pregnancy
Vyvanse can be continued during pregnancy if required for daily functioning, as the documented risks are very low and do not outweigh the benefits of treatment for moderate to severe ADHD. 1
Key Safety Evidence
The American College of Obstetricians and Gynecologists states that amphetamines (including lisdexamfetamine) do not appear to be associated with major congenital malformations, including cardiac malformations, or other significant adverse developmental outcomes. 1 This is further supported by a 2023 Danish population-based cohort study of over 1 million births, which found no increased risk of neurodevelopmental disorders, vision or hearing impairments, epilepsy, seizures, or growth impairment in children exposed to ADHD medications (including lisdexamfetamine) during pregnancy. 2
Small Potential Risks to Monitor
While overall reassuring, there are some modest risks to be aware of:
Gastroschisis: Possible increased risk (adjusted OR 3.0; 95% CI 1.2-7.4), though the absolute risk remains extremely small given the population prevalence of only 0.05%. 1
Preeclampsia: Possible small increased risk (adjusted RR 1.29; 95% CI 1.11-1.49). 1
Preterm birth: Continued stimulant use in the second half of pregnancy may be associated with a small increased risk (adjusted RR 1.30; 95% CI 1.10-1.55). 1 A 2025 Scandinavian study confirmed this modest association, particularly with longer durations of use in late pregnancy. 3
Spontaneous abortion: Possible increased risk, though confounding by indication cannot be ruled out. 1
Risks of Untreated ADHD
Discontinuing Vyvanse during pregnancy can lead to worse mental health outcomes and significant functional impairment in the pregnant individual, which may subsequently have negative impacts on the developing fetus. 4 Untreated ADHD itself has been shown to be associated with increased risks for spontaneous abortion and preterm birth, meaning the disease itself poses risks independent of medication. 4
Clinical Management Algorithm
If ADHD symptoms are moderate to severe and impair daily functioning:
- Continue Vyvanse at the current effective dose throughout pregnancy. 1, 4
- The magnitude of documented risks is very low and does not outweigh the benefits of treatment. 1
If ADHD symptoms are mild and do not significantly impair functioning:
- Consider a trial of gradual discontinuation before pregnancy. 4
- Implement non-pharmacological interventions for ADHD. 1
If unable to discontinue:
- Continue current medication or reduce to lowest effective dose. 4
- Consider intermittent use on an as-needed basis. 4
Pregnancy Monitoring
Monitor carefully throughout pregnancy for:
- Blood pressure checks for preeclampsia. 4
- Fetal growth assessments. 4
- Signs of preterm labor, particularly in the second half of pregnancy. 4
- Ensure appropriate maternal weight gain. 4
Neonatal Monitoring
Monitor infants carefully after delivery for: 1
- Irritability and agitation
- Insomnia and sleep disturbances
- Feeding difficulties
- Poor neonatal adaptation
- Appropriate weight gain and developmental milestones
The FDA label notes that infants born to amphetamine-dependent mothers have an increased risk of premature delivery and low birth weight, and may experience withdrawal symptoms. 5
Important Caveats
- This information applies to therapeutic use of Vyvanse and does not apply to non-prescribed amphetamine use in persons with stimulant use disorder. 1
- Amphetamines cross the placental barrier and can cause vasoconstriction, potentially decreasing placental perfusion. 1, 5
- Limited published information exists specifically on lisdexamfetamine use during pregnancy, so pregnancy risk information for amphetamines in general should be considered. 1
- The FDA label advises patients to notify their healthcare provider if they become pregnant or intend to become pregnant during treatment. 5
Breastfeeding Considerations
The FDA label advises women not to breastfeed while taking lisdexamfetamine. 5 However, the American College of Obstetricians and Gynecologists recommends that treatment should not be stopped if required for daily functioning, as documented risks are very low. 6 If breastfeeding is chosen, monitor the infant for irritability, sleep disturbances, and feeding difficulties. 6