Treating for Two: ADHD Meds in Pregnancy

Stimulants During Pregnancy: Insights from Research

Many of the largest studies on the reproductive safety of stimulant medications are reassuring, finding no increased risks for adverse outcomes like congenital malformations, perinatal death, and obstetric complications.¹ More recent studies have suggested a potential association between the use of methylphenidate and cardiac malformations, particularly ventral septal defects (a hole in the heart).² Though the risks are low, and confounding variables exist, the patient and her obstetrician could consider doing a fetal echocardiogram, a procedure that provides additional data on the baby’s heart development, if she chooses to continue her methylphenidate throughout pregnancy. Other women decide to stop using stimulant medications during pregnancy due to a lack of data about long-term neurodevelopmental outcomes for children. These women would do well to consider nonpharmacologic treatment for ADHD, including cognitive behavioral therapy, a reduced workload, stress-mitigating strategies, and coaching and support groups.

[Download: Navigating Natural ADHD Treatment Options]

A small study showed that women who discontinued stimulant treatment during pregnancy, but who didn’t stop taking their antidepressant medication, experienced a clinically significant increase in depression.³ They also were more likely to experience conflict within their family, rate parenting as more difficult, and report feeling more isolated.

Conversely, many perinatal women (the time before and after the birth of a child) have reported significant benefits from taking their ADHD stimulant medication, including feeling more “together,” centered, and generally competent. This, in turn, can have a positive impact on functioning and parenting. One change in ADHD treatment can potentially lead to psychiatric symptoms, which doctors seek to avoid during the transition to motherhood.

ADHD Treatment Considerations

The new demands of caring for their babies during a time of changing hormone levels, infant feedings, and sleep disruption are exceedingly difficult for some women. Being an effective mother requires the ability to get and stay focused, modulate attention, control impulsivity, and utilize executive function skills. Women with ADHD struggle in these domains, yet this population and the course of their condition during pregnancy and the postpartum period have received little attention and systematic study.

[Read: Women, Hormones, and ADHD]

Women of reproductive age with ADHD would benefit from working with a psychiatrist and/or medical team to understand the impact of hormones on ADHD throughout the lifespan, and the interplay with medication. For example, stimulants may be less effective during the second half of the menstrual cycle, and hormone replacement therapy can improve ADHD symptoms in postmenopausal women. Working with an integrated, informed, and supportive health care team can lead to better outcomes for women.

ADHD Treatment in Pregnancy: Next Steps

• Read: Motherhood with ADHD
• Download: Free Guide to Hormones & ADHD in Women
• Download: Free Parenting Guide for Moms & Dads with ADHD
• Read: Why ADHD in Women is Routinely Dismissed, Misdiagnosed, and Treated Inadequately

Allison S. Baker, M.D., is a child and perinatal psychiatrist at Massachusetts General Hospital.