About 1.4 million people in the U.S. have been diagnosed with ADHD, and about 60-80% of children diagnosed with ADHD will need to take their medication into adulthood. When girls diagnosed in childhood become reproductive-aged women, they face challenging decisions regarding how to proceed with their treatment when they are also family planning.
There are different kinds of medication used to treat ADHD. Among the most commonly prescribed are methylphenidate (like Ritalin) and amphetamine derivatives (like Adderall).
If you research the reproductive safety of these medications, it is exceedingly difficult to find any data about these medicines being prescribed during pregnancy. The great majority of information available is about these compounds being abused/used illicitly during pregnancy and, thus, associated with obstetric complications and postnatal problems in behavior, emotions, memory, attention and growth.
However, taking a prescribed daily dose of methylphenidate or other ADHD medications during pregnancy has in fact not shown increased risk for congenital malformations (1, 2). There is likewise no known increased risk for obstetric complications like preterm delivery or low birth weight. We even have longitudinal data for babies up to a year of age with normal development (3).
Although the default medical position is to interrupt any “non-essential” pharmacological treatment during pregnancy and lactation, in ADHD this may present a significant risk. As perinatal psychiatrists, we evaluate each case carefully and review a risk-risk analysis prior to developing a treatment plan for pregnancy: the risks of medication exposure throughout the pregnancy weighed against the risks of untreated ADHD, including driving safety, and major impairment in fulfilling occupational and domestic roles.
Here at the MGH Center for Women’s Mental Health, we are conducting a pilot, prospective, longitudinal study looking at the course of ADHD across pregnancy and in the postpartum. This is the first study of its kind, and an important step towards addressing the paucity of data regarding ADHD and its treatment during this sensitive period.
Allison Baker, M.D.
For more information:
- Diav-Citrin, O., Shechtman, S., Arnon, J., Wajnberg, R., Borisch, C., Beck, E., & Ornoy, A. (2016). Methylphenidate in Pregnancy: A Multicenter, Prospective, Comparative, Observational Study. The Journal of clinical psychiatry, 77(9), 1176-1181
- Pottegård, A., Hallas, J., Andersen, J. T., Løkkegaard, E. C., Dideriksen, D., Aagaard, L., & Damkier, P. (2014). First-trimester exposure to methylphenidate: a population-based cohort study. The Journal of clinical psychiatry, 75(1), 88-93.
- Bolea?Alamanac, B. M., Green, A., Verma, G., Maxwell, P., & Davies, S. J. (2014). Methylphenidate use in pregnancy and lactation: a systematic review of evidence. British journal of clinical pharmacology, 77(1), 96-101.