Can a Pregnant Patient Take Adderall?
Yes, continuing Adderall during pregnancy is generally safe and recommended if required for daily functioning, as amphetamines are not associated with major congenital malformations, and discontinuing treatment can lead to worse maternal outcomes that may harm both mother and fetus. 1
Primary Safety Evidence
The American College of Obstetricians and Gynecologists states that amphetamines do not appear to be associated with major congenital malformations, including cardiac malformations, or other significant adverse obstetrical or developmental outcomes. 2
Research on the potential teratogenicity of ADHD medications, particularly stimulants, is largely reassuring with low risk of major malformations. 2
Multiple studies examining amphetamine exposure during pregnancy have not found increased rates of major birth defects when properly adjusted for confounding factors. 3
Small Potential Risks to Monitor
While the overall safety profile is reassuring, there are three small potential risks that warrant monitoring:
Gastroschisis: Possible increased risk (adjusted OR 3.0; 95% CI, 1.2-7.4), but this comes from one study with possible confounding by indication, and the absolute risk remains extremely small given the population prevalence of only 0.05%. 2, 1
Preeclampsia: Possible small increased risk (adjusted RR 1.29; 95% CI, 1.11-1.49), though other studies have not found this association. 2, 1, 4
Preterm birth: Possible small increased risk when stimulant use continues in the second half of pregnancy (adjusted RR 1.30; 95% CI, 1.10-1.55), but this risk appears small. 2, 1, 4
Risks of Discontinuing Treatment
The risks of stopping Adderall during pregnancy must be weighed against the small potential risks of continuing:
Discontinuing psychostimulant treatment during pregnancy leads to worse mental health outcomes and significant functional impairments in the pregnant individual. 2, 1
Untreated ADHD is associated with increased risks for spontaneous abortion and preterm birth. 2, 1
One study found that women who ceased dexamphetamine during pregnancy had greater odds of threatened abortion (OR: 2.28; 95%CI: 1.00,5.15) compared to those who continued. 5
The functional impairment from untreated ADHD can significantly impact the ability to care for oneself safely during pregnancy, overall mental health, and management of co-occurring conditions. 6
Treatment Recommendations
The American College of Obstetricians and Gynecologists recommends that treatment with ADHD medications should not be stopped if they are required for the daily functioning of the pregnant person, as the magnitude of documented risks is very low. 2, 1
Dosing Strategies to Minimize Exposure
Consider intermittent use on an as-needed basis to maximize functioning while reducing overall fetal exposure, given that stimulants have rapid effects. 1
Use the lowest effective dose that maintains adequate daily functioning. 1
The usual dosage range for Adderall is 10-50 mg daily, with typical starting doses of 10 mg in the morning and titration by 5 mg weekly. 2
Critical Monitoring During Pregnancy
Blood pressure checks: Monitor regularly for preeclampsia risk. 1
Appropriate weight gain: Track throughout pregnancy. 1
Fetal growth monitoring: Perform regularly to assess for any growth concerns. 1
Monitor infant at birth: Watch carefully for irritability, insomnia, and feeding difficulty. 2, 1
Important Caveats
This information applies to therapeutic use of amphetamines during pregnancy and does not apply to non-prescribed amphetamine use in persons with stimulant use disorder. 2, 1
The FDA classifies Adderall as Pregnancy Category C, meaning dextroamphetamine should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. 7
There are practically no data on possible long-term neurodevelopmental effects of amphetamines, which represents a knowledge gap. 3
Alternative Considerations
If a patient wishes to minimize medication exposure:
Dialectical Behavior Therapy (DBT) can be considered as an adjunct or alternative, with four modules addressing mindfulness skills, distress tolerance, interpersonal effectiveness, and emotion regulation. 2, 1
DBT has shown decreased ADHD symptoms, improved neuropsychological functioning, and reduction of co-existing anxiety and depression. 2, 1
Bupropion is a possibility, particularly for individuals requiring treatment for co-occurring depression, given available safety data in the perinatal period, though it is not as efficacious as stimulants for ADHD treatment. 1
Risk-Benefit Context
The number needed to harm is approximately 63 for amphetamine exposure and preeclampsia, and larger (>500) for other adverse outcomes, indicating relatively low absolute risk. 4 Women need to weigh the benefits of continuing Adderall against these small potential gestational risks, but the evidence strongly supports continuation when the medication is required for daily functioning. 4