ADHD Medications During Pregnancy and Breastfeeding
During pregnancy, women must make choices based not only on their own needs, but on the needs of their unborn child. For most women, this might include making sure they eat a healthy diet and getting extra rest. But for women with ADHD, the choice of whether or not to continue using medication might be the most difficult one.
Many women depend on medications for ADHD to help control symptoms, such as inattention, impulsiveness and hyperactivity. During pregnancy, however, they must decide whether taking the medication is important enough to risk harm to their baby.
According to Dr. Patricia Quinn , questions involved in deciding on the safety of medication include:
- What effect, if any, will the medication cause on the developing fetus? Is there a risk of physical deformities? Is there a risk of later behavioral or cognitive problems?
- Will medication possibly cause premature birth?
- Will a baby be born small?
- Will the baby have withdrawal symptoms if exposed to ADHD medications while in the womb?
- What other long-term effects may result from taking ADHD medications?
Because research into whether these medications would cause harm would require women to take medications, very little data is available on what the risks are and how much of a risk the medication would be. Animal studies, although with obviously less risk to unborn children, are not always reliable because the amount of medication given to animals is often so much higher than what is normally prescribed that the information gained is not specific to humans.
A Few Study Results
According to the College of Family Physicians of Canada, the following are some of the few studies that have been completed :
- Some studies have been completed on women who abused amphetamines during pregnancy. These studies showed low birth weight, prematurity, and increased comorbidity. The study, however did not take into consideration possible other drugs or alcohol being used or other lifestyle choices.
- Another study looked at women taking dextroamphetamines for weight loss. This study also indicated a slightly lower birth weight but no difference in length or head circumference.
- A study showed no significantly higher risk of physical deformities or malformations in women taking amphetamines.
- A study of methylphenidate during pregnancy showed a higher rate of babies born prematurely, with cognitive impairments and being born with symptoms of withdrawal. The study, however, did not include a control group and did not take into account use of cigarettes, alcohol or other drugs.
- Animal studies on atomoxetine showed decreased fetal weight and decreased pup survival. However, dosing in this study may or may not result in any results relating to human consumption of the medication.
Most researchers are not willing to make definitive statements as to the safety of ADHD medications based on these limited studies.
The Food and Drug Administration (FDA)
The FDA has five classes of medication (A, B, C, D, X), from A, which have not shown to have a risk to either the mother or the fetus, to class X, which are medications that have a high risk of causing birth defects.
Medications to treat ADHD are listed by the FDA as Class C medications. This means they may be potentially harmful, based on animal studies but no information, or limited information, is available from human studies.
Making the Decision
Ideally, a woman should consider the risks of medication when she is planning to have a child, however, often the decision is made once a woman knows she is pregnant, somewhere between 4 and 6 weeks after conception.
A woman should discuss the possible risks with her doctor and come to the best decision for her and her unborn child. Some women feel the best course is to stop all medications while others feel their need for medication outweighs any potential risk. This is an individual decision which should be made with the advice of your doctor and input from your spouse or significant other.
Many women, however, find that during the second and third trimesters, the level of estrogen helps to decrease ADHD symptoms and they manage well without medication.
While there is still very little information available on ADHD medications during breastfeeding, some information has shown that amphetamine use can cause symptoms of addiction and withdrawal in infants when their mother uses amphetamines while breastfeeding. It is recommended that this type of medication not be used while breastfeeding. For other types of ADHD medications, there is an virtually no reliable studies.
If you continue to take medication, your pediatrician would be able to provide additional information on possible reactions in the baby and warning signs you should be aware of.
 "Medications to Treat AD/HD and Their Use During Pregnancy", 2002, Patricia O. Quinn, M.D., National Center for Gender Issues and AD/HD
 "Exposure to Attention Deficit Hyperactivity Disorder Medications During Pregnancy", 2007, Caitlin Humphreys, M.D., et al, The College of Family Physicians of Canada
"Medications in Pregnancy: General Principles", 2000, Oct 6, Marjorie Greenfield, M.D., Dr.Spock.org