Mass General Hospital

Harvard Medical School

Clinical Update 2010: Use of Stimulant Medications in Pregnancy

Approximately 4% of the adult population suffers from ADHD. Attention and executive functioning difficulties also occur in those with mood and psychotic disorders and require treatment strategies similar to those used to address ADHD symptoms. First line medications most often used to treat ADHD in adults are Dextroamphetamine (Dexedrine, Adderall) and Methylphenidate (Concerta, Ritalin, Metadate).

For women with mild to moderate ADHD symptoms, we frequently recommend discontinuing medication and switching to a non-pharmacologic intervention.  On the other hand, some women have severe symptoms which may interfere with their daily functioning and may potentially affect the pregnancy. One option would be to switch to an antidepressant that may be effective for treating ADHD, such as a tricyclic antidepressant or bupropion.  However, many women may not respond or tolerate these agents and may thus consider treatment with a stimulant during pregnancy to maintain their level of functioning.

Most data on Dextroamphetamine exposure in pregnancy comes from studies of drug abuse. Amphetamine or cocaine abuse is associated with low birth weight, prematurity, and increased maternal and fetal morbidity. These are likely related to placental vasoconstriction (Plessinger 1993).  However, decreased birth weight was also noted in infants born to women who were prescribed Dehtroamphetamine at lower therapeutic dosages to control weight gain (Naeye 1983).  If medication was continued beyond the 28th week of pregnancy, there was a 100g to 400g reduction in weight of the infants, with no change in birth length or head circumference (Naeye 1983; Golub 2005).

Methamphetamine use in pregnancy was associated with adverse maternal and neonatal outcomes (Good 2010).  In a chart review including 267 women who had positive urine tests for methamphetamine compared to a control group of women with negative urine tests, the authors reported a higher risk of  preterm delivery (52% vs. 17%), low Apgar scores (6% vs. 1–2%), and neonatal mortality (4% vs. 1%).

Methylphenidate abuse is associated with premature birth, growth retardation and neonatal withdrawal symptoms (Debooy 1993). Unfortunately, this study had only 38 participants, no control group and was confounded by the abuse of nicotine, alcohol and other drugs during the pregnancy.

Available data on the therapeutic use of Amphetamine in pregnancy shows no increase in the risk of congenital malformations (Milkovich 1977). A large cohort study monitoring 50,282 women with medication exposure during pregnancy (including 367 women taking Dextroamphetamine and 215 unspecified Amphetamines in the first trimester) demonstrated no increase in the risk of malformation in exposed infants (Golub 2005).

There are fewer data on the teratogenicity of Methylphenidate (Concerta, Ritalin) in pregnancy. The literature includes 69 cases studies (reviewed in Humphreys 2007), with one cardiac defect reported. However, none of the studies were statistically powered to allow for definitive conclusions regarding the reproductive safety of Methylphenidate exposure.

In conclusion, there are not enough data on use of stimulant medications in pregnancy to allow definitive conclusions about their reproductive safety. Available data for Amphetamines suggest no increase in the risk of malformation when used at therapeutic doses, while infants might have slightly lower birth weights.  Human data on Methylphenidate is limited and we cannot rule out the risk of malformation given the available information.   Alternative pharmacologic treatment options include tricyclic antidepressants, bupropion and clonidine; these drugs have more evidence to support their safety in pregnancy.

Snezana Milanovic, MD, MSc

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27 Responses to Clinical Update 2010: Use of Stimulant Medications in Pregnancy

  1. docmom February 21, 2011 at 12:30 pm #

    I find this article very helpful and grounded. The ability for all pregnant women to stop medication during pregnancy is often not realistic nor in the best interest of the patient. These women are faced with difficult decisions backed by a dearth of scientific information and are often left feeling guilty if they choose to stay on medication. I appreciate your interest and up to date information in this area. As a physician myself, an untreated depressed “subfunctioning” pregnant woman who is at risk for adverse psychosocial outcomes is as concerning as a pregnant women taking therapeutic doses of stimulants during pregnancy.

  2. DexMama January 4, 2012 at 12:44 am #

    I wonder how wise it is to inform responsible pregnant women who have ADHD to stop taking medication when the only real studies have been on drug addicts taking far more than the recommended doses. As a mother of a healthy three year old who took Dexedrine 10 spansules (two per day) throughout my pregnancy, I believe I am proof that more studies are needed. My daughter was 9 lbs, 8.5 oz, very active and alert from the beginning. My OB told me to take the least amount of Dex I could to get the work I needed to done. I’d originally been taking 4 – 10 mg spansules per day, so I cut my daily dosage in half. I think moderation is obviously best when it comes to anything while pregnant. My doctor equating lower doses of stimulant meds to caffeine and said that taking as little as possible to get by shouldn’t hurt my baby and it didn’t. I don’t think I’m the exception and would be glad to be part of any study to prove this to people who want to rid the world of the stimulants me and other people like me need to function.

  3. Anonymous April 23, 2012 at 5:17 pm #

    Thank you DexMama. I just found out that I am pregnant. I’ve been taking 40 mg of Desoxyn (methamphetamine) twice a day for 7 years now. This is the ONLY drug that has ever worked for me, and I’ve tried them all. I’m horrified about going off of my meds during pregnancy. I might consider reducing my daily dose, but I also disagree with the studies being inaccurate. The animal studies that have been conducted consisted of a rat being given 50 times the regular human dose. Of course this would cause problems, obviously. And the supposedly low birth weights have been caused by women using illegal street drugs. Just because I have ADD doesn’t mean I’m a criminal. I’d love to ditch this stigma. I’m with you.

  4. John C Raiss, MD April 30, 2012 at 12:39 pm #

    I’ve been asked several times in the last few months by women if they can continue on their stimulants in pregnancy, and I have printed out this site as the best resource I can find on the subject. My clinical gut feeling is that the stimulant story will parallel the antidepressant story in pregnancy, i.e. they will turn out to be safe when carefully used in the lowest dose that does the job, in both pregnancy and breastfeeding.

  5. MGH Center for Women's Mental Health May 1, 2012 at 9:47 am #

    @John C Raiss, MD, Thank you for your comments. With more information, we will probably find that the stimulants are relatively benign when used during pregnancy. However there is one big difference between the stimulants and antidepressants. Many women absolutely need to remain on antidepressants to remain well. On the other hand, most women take stimulants to improve cognitive functioning or wakefulness and might do relatively well without the stimulants, at least for a short period of time. Given that important difference, we tend to prescribe stimulants only to the women with severe cognitive difficulties or sleep disorders such as narcolepsy.

  6. Anne Miller May 21, 2012 at 12:30 pm #

    I appreciate the respect for the effects of untreated severe AD/HD in pregnant women, especially its effects on comorbid depression. I am looking at an alternative to stimulants in a woman due to wanting to avoid any possible placental vasocontriction. Can anyone direct me to information specificaly on Guanfacine in pregnancy? Any information on how it might increase placental blood flow?
    Anne Miller

  7. Mobaby August 20, 2012 at 6:27 am #

    I know that more rational clinical trials must be done and I’m 28 weeks pegnant with ADD and all of my doctors have advised me to stop taking my medication. Wellbutrin wasn’t a good drug for me prior to pregnancy, and dose not help with my symptoms. I’m on the brink of loosing my job and non pharmologic methods have not worked for me in the past .

  8. Anna October 5, 2012 at 2:37 am #

    I am printing this to take to my next doctor’s visit, thanks for the timely info.

    It seems like if there were huge risks with stimulants we’d have heard much more about these from women taking them in the 50s/60s when they first gained popularity (like we heard about thalidomide?)

  9. k g November 10, 2014 at 2:10 pm #

    I am trying to get pregnant and might already be but am waiting another week to take a test. My husband and i have gone back and forth on this subject. I set him straight one day. Did he think if i weren’t sure that I needed dexedrine to function in daily life that i wouldn’t give it up for my baby’s protection! Of course I would! But without it I would be a harm to the baby because I would be a harm to myself! I have a severe case of ADD and my dose is 15 mg pills with the option to take 3 a day. Normally i take 2 pills in the morning and 1 around 3 pm. Now i am taking just 2 and i will have to see if i can go down to 1. I did plan it so while pregnant and breastfeeding i would not have to work. I would never be able to function in a job on a low dose especially while pregnant not just because of the lack of attention but because i would not be able to stay awake nor drive myself either. Infact i will probably only drive short distances if i drive at all. I will have to depend on my husband to drive me as well as perform basic things for me because my ADD causes me to be dangerously clumsy. My psychiatrist told me her mom took Ritalin while pregnant with her brother and sister and they both are above average in intelligence. She doesn’t for see a problem nor did my previous dr. But we’ll see what my OBGYN has to say when the time comes.

  10. Jennifer December 9, 2014 at 12:56 am #

    Is there a chemical that is produced during pregnancy that replaces ADHD medication?

  11. Jessica December 17, 2014 at 8:39 pm #

    I have been dealing with ADD for many year but stared taking Adderall last summer, few months back I found out that i was expecting, this pregnancy has been so hard on me I’m mentally drain to the point where I even consider terminating it and true me that’s very hard for me to think about even doing, my doctor stop giving it to me, I still don’t know what to do.

  12. MGH Center for Women's Mental Health December 18, 2014 at 11:19 am #

    Not that we are aware of.

  13. Clare April 14, 2015 at 10:09 am #

    I currently take concerta for adhd. My husband and I would like to conceive a child this year. What is a good amount of time to go off concerta before conceiving?

  14. MGH Center for Women's Mental Health April 29, 2015 at 10:41 pm #

    Concerta has a relatively short half life, so it is pretty much gone with 48 hours.

  15. Kelly July 22, 2015 at 1:02 am #

    I have ADHD and was medicated with my #3 pregnacy was taking Dex 60mg a day.I was part of a case study for pregnant women that take stimulants and they all so followed up on my baby after birth.The problem with the stimulant drugs i was told it does cut the oxygen supple to the blood being a smoke my baby was getting a double wamy. As i tried very hard to stop smoking and had trouble doing so
    I cut it down to 30mg a day Then cut it out all together at 18 weeks as was very concerned for my baby.I found my self very unstable sleeping all the time.
    I had a very healthy baby girl in which they followed up quite some time after birth.
    Now found out i am pregnant with #4 i don’t smoke anymore but still taking Dex will continue to take with this pregnancy but will cut dose in half just so i can still function like a normal person.

  16. concernedmama August 19, 2015 at 5:11 pm #

    I am forty-one years old and have been medically prescribed dexadrine for over 8 years. I recently discovered that I am pregnant…7 weeks now. I am slowly decreasing my dosage; however, I feel so angry and exhausted and miserable. My midwife looks down upon any type of stimulants during pregnancy and my husband doesn’t understand. I own a preschool and have many responsibilities. Thank you for sharing your stories. I guess I have to stop, but I am more tired and angry than I have ever been in my life. I wish that I could be assured that a low dose would not hurt the baby. Any suggestions or first hand experience would be helpful. Thank you.

  17. Desire November 29, 2015 at 10:05 am #

    I am currently taking concerta capsule 27 mg Sometimes I alternate with ritalin 20 mg by breaking in half. I am pregnant for 2nd time but had a D&C last pregnacy due to stop of growth in the baby’s heartbeat. I an scared this go around. Was trying to wean my self off with using the ritalin 20 mg taking only half in morning then stopped taking for 3 days. Then today I felt I needed my 27 mg. I feel so guilty. But i have ADD and need it to help me through my day. Prob should take a half 20 mg tomorrow and call dr again. He said it was my call last pregnancy but I don’t want to risk anything this time.

  18. Narcoleptic Worry Wart January 2, 2016 at 10:44 pm #

    Thank you for this info! I’m 11 weeks pregnant and prescribed Dexadrine XR 15mg twice daily for Narcolepsy. I’ve been able to cut my dose by half on most days, however I do notice a dramatic difference in my ability to stay awake. I feel normal on my regular dose, but am worried about the effect it could have on the baby. When I don’t take any for even a day I can hardly function. Basically I sleep 18+ hours and eat when awake. I feel very depressed when this happens. My original plan was to stop use before the 3rd trimester, but now the idea of being off my medicine overwhelms me with worry and makes me stressed out and depressed. I dread the idea of working my job without medication. I really wanted to breastfeed too, but have been having second thoughts because I’m scared of what my life would be like if I stopped the medication. My husband is very worried about the effects this medication will have on the baby both during pregnancy and breastfeeding. Honestly it’s driving us both up a wall with worry.

  19. Niqi Black March 20, 2016 at 12:50 pm #

    OK, I feel like I might be pregnant, but I have to wait till I can afford a pregnancy test first, I don’t wanna take my concerta without knowing if it will hurt the fetus. I need to know that first.

  20. Jamie w May 2, 2016 at 2:05 pm #

    I took 10 mg adderall xr and lamictal with both pregnancies and my babies are healthy and advanced for the age! They are also very well behaved!

  21. BrookT May 24, 2016 at 5:43 pm #

    Thank you so much for sharing this information! I have been so worried about the development of my babies brain and this is so great to hear.

  22. Jamie June 14, 2016 at 12:59 am #

    I’m so scared!! I just found out that I’m pregnant and I’ve already had 3 children, now this will be my 4th. I suffer from ADHD real bad and I’m afraid to be off the medication!! I also suffer from depression really bad. The combination of not being on my meds during my pregnancy scares the living day lights out of me!! On top of it All I’ve had postpartum depression with 3 of my children!!
    Please someone give me advice!

  23. Kasey June 24, 2016 at 2:05 pm #

    I took 30mg of Adderall a day while pregnant and 5 weeks ago I gave birth to my baby 13 weeks premature. I don’t know if Adderall contributed to his prematurity, but I do wish that I would have stopped taking it while pregnant. If I had not been on Adderall, I could be certain that it wasn’t a contributing factor. Even though my continued use of Adderall was given the ok by my OB/GYN, I struggle with guilt. I can’t be certain that he wouldn’t have gone full term if I wasn’t using a stimulant. His prematurity may likely effect him the rest of his life. My suggestion is so stop the use of stimulant medications for the sake of certainty that it won’t effect your child.

  24. RipVanWinkle August 24, 2016 at 1:37 pm #

    My husband and I are presently trying to conceive and are faced with the issue of continuing on with my medications as well. I have a diagnosis of narcolepsy and currently take 15mg of Dexedrine 1x/day. If not for the Dexedrine I honesty don’t know how I would function. I echo Narcoleptic Worry Warts 18+ hours of sleep and constant eating when not medicated. I did a 1 month trial off my medications ( with consent from my doctor) prior to trying to conceive to help plan for what accommodations we might need to make and I gained 20+ lbs in 4 weeks- I’ve never eaten so much to stay awake in my life. After reading all the literature I remain on the fence. We even consulted the FRAME clinic in our hometown (Fetal Risk Assessment from Maternal Exposure) and was told that the data remains squed as many of the study participants abused a variety of drugs and engaged in what would be considered more “high risk behaviours”. They indicated that “at therapeutic levels” they would be most concerned about fetal growth- which could be monitored. They weren’t however able to identify to me what they would consider a “therapeutic dose”. I’ve read quite a few different peoples stories and it appears many individuals actually take significantly more than I do for the same condition. I’m prepared to cut my dose in half, but it won’t be without sacrific. Unmedicated I am not able to operate a vehicle and will likely need to take significant time off work. If anyone know of any literature out there that might have more information on fetal stages of development and continued use of amphetimines that would be helpful. Is it better to take a little early and stop later, or stop early and continue with small doses of medication following the first or second trimester- I know all trimesters are important, but is one more important than the other??

  25. rachaelr88 September 11, 2016 at 10:52 pm #

    It would be great if there was a new and thorough clinical trial on pregnant women with adhd and the effects of medications, i’m sure so many women would volunteer as we need the knowledge of whether it harms the baby or not and if lower dosages or stopping completely is best. I’ve tried to find one but majority is for children.

  26. Mommy,RN,BSN November 6, 2016 at 11:19 pm #

    I found this article very helpful. As a Registered Nurse and I mom-to-be, my main concern is monitoring safe dosage for both baby and I. I read massive amounts of blogs, literature, and scholarly journals but there is really not much scientific evidence out there. My first instinct was to give up adderall but was left not being able to function in my activities of daily living. Yet, every single time I took even a quarter sometime half of my dosage, I felt a massive amount guilt.

    I finally found relief when I consulted with my OB at week 6 of my pregnancy. Who gave me reassurance that what I have been doing is just FINE. That I have done my research and probably have more knowledge about this subject than he does. I had brought up that premature births and low birth weights was a concern since there it has been found in a clinical trial with rats. He replied with ” well, you are not a rat & the FDA would advise of against using adderall use to prevent a lawsuit.”

    Before pregnancy I was taking Adderall XR, 30mg, PO, OD, breakfast & Adderall IR, 20 mg, PO, OD, before 4pm. I have completely ditched the XR dose since its half life is longer therefore staying in your system for a longer period of time. I only take a 5mg Immediate release tablet & occasionally a 10mg dose when I really need it. I don’t take it when I’m not at work or when I plan not do anything (mostly on weekends.)

    My physicians agrees with my game plan & I am able to function enough to get my work done. Ladies, I guess when it comes down to it, just keep an open communication with your physician and take things in moderation. I will update well being of baby when he or she pops out. 🙂 Happy pregnancy ladies & I hope this helps any of you.

  27. Katrina November 23, 2016 at 1:42 am #

    I’m currently 33 weeks pregnant and have been taking adderall throughout my entire pregnancy with the exception of 8 weeks during my first trimester. I take 30 mg twice a day and my baby girl has been a little bit bigger than “normal” throughout the entire pregnancy.

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