Bupropion and Lisdexamfetamine Use During Pregnancy
Bupropion (Wellbutrin) can be continued during pregnancy if already stable on it, as the small absolute risk of specific cardiac defects is generally outweighed by the benefits of treating maternal depression; however, lisdexamfetamine (Vyvanse) should be avoided during pregnancy due to lack of safety data and the general contraindication of stimulants in pregnancy.
Bupropion (Wellbutrin) in Pregnancy
Risk Profile
Bupropion does not increase the overall risk of major congenital malformations above baseline 1, 2.
There is a small absolute increased risk of two specific cardiovascular defects with first-trimester exposure 3, 1:
A possible increased risk for diaphragmatic hernia exists with an adjusted odds ratio of 2.77 (95% CI, 1.34-5.71), though the absolute risk remains extremely small given the population prevalence of only 0.012%-0.031% 3, 1, 2.
There is a possible increased risk for spontaneous abortion 3, 1, 2.
Clinical Decision-Making
If you are already taking bupropion before pregnancy and it is controlling your depression effectively, continue at the current well-tolerated dose 1, 2. The American College of Obstetricians and Gynecologists specifically recommends this approach because the small absolute risks are outweighed by the benefits of treating maternal depression 1.
Do not abruptly discontinue bupropion when it is required for daily functioning, as untreated maternal depression carries its own risks for both mother and fetus 2.
The benefits of treating maternal depression may outweigh the small absolute increased risks of specific cardiac defects in most clinical scenarios 3.
Monitoring Requirements
- Perform regular fetal growth assessments throughout pregnancy 2.
- Conduct routine maternal blood pressure checks 3, 2.
- Ensure appropriate maternal weight gain according to gestational guidelines 3, 2.
Important Caveat
- All medications for weight management, including combination products containing bupropion, are contraindicated in individuals who are or may become pregnant 3. This applies only to bupropion formulations indicated for weight loss, not those used for depression or smoking cessation.
Lisdexamfetamine (Vyvanse) in Pregnancy
Risk Profile and Recommendation
Lisdexamfetamine and other stimulants lack adequate safety data in pregnancy and should be avoided (general medical knowledge regarding stimulant use in pregnancy).
The evidence provided focuses on bupropion as an alternative to stimulants in the perinatal period, particularly for individuals requiring treatment for co-occurring depression 2. This recommendation implicitly suggests that stimulants themselves are not preferred during pregnancy.
Bupropion may be considered as an alternative to stimulant medications for pregnant women with ADHD, especially when co-occurring depression also requires treatment 2, though recognize that bupropion is generally less efficacious than stimulants for controlling ADHD symptoms 2.
Clinical Approach
If you are taking Vyvanse for ADHD and become pregnant, discuss switching to bupropion with your provider if medication is absolutely necessary, particularly if you also have depression 2.
If ADHD symptoms are manageable without medication, discontinue Vyvanse during pregnancy.
Non-pharmacological interventions for ADHD should be maximized during pregnancy.
Common Pitfalls to Avoid
Do not discontinue bupropion abruptly due to pregnancy if it is controlling significant depression 2. The risks of untreated maternal depression (including poor prenatal care, substance use, suicide risk) often exceed the small absolute risks of specific cardiac defects.
Do not confuse the weight-loss formulation of bupropion (Contrave) with depression/smoking cessation formulations 3. Weight-loss products are absolutely contraindicated in pregnancy.
Do not assume that because odds ratios appear elevated (2.9 for VSD), the absolute risk is high 3, 2. The baseline rates of these defects are very low, so even a tripling of risk results in small absolute numbers.