ADHD Stimulant Medication During Pregnancy

Should a pregnant woman with ADHD take stimulant medication like Ritalin, Adderall XR or Concerta? There is no clear cut answer, but there are risks to the fetus that should be considered.

With more and more women being diagnosed and treated for AD/HD, the question of safe use of stimulant medications during pregnancy has become more critical. In general, stimulants (either the amphetamines like Adderall or methyphenidate like Concerta, Ritalin LA and Metadate CD) are all considered "Category C" teratogens. That means that they should only be used when the risk to the mother outweighs the risk to the fetus.

To date, the effects of stimulants during pregnancy have only been studied in animals, where defects were seen in the offspring when the mothers were given very high doses of the stimulants. The doses of stimulants given to animals for these studies have been 41x and 12x the usual human dose. The literature contains individual case reports of women who have taken stimulants during their pregnancy and, clinically, there have been many other women who have taken stimulants and have had normal babies.

The important questions for a woman who is being treated for AD/HD and who is thinking about getting pregnant or who recently learned that she is pregnant are the following:

• Should she discontinue stimulants prior to becoming pregnant?
• Should she continue stimulants after her first 3 months?
• Should she discontinue medication during the entire pregnancy?
• What are the risks both to the mother and the baby if her AD/HD goes untreated?

Each woman needs to decide the answers to these questions for herself after considering all of the available information and discussing the issue with both the child's father and her physician. The problems with the stimulants have to do with cardiac defects, which usually occur because of problems during the formation stages of each organ system during the first trimester. To date, there are no large-scale studies to provide us with answers.

As for breastfeeding while taking stimulant medication, as of August 2006, WebMd ADHD medical expert, Richard Sogn, MD, warns that all medications are excreted into breast milk, exposing them to the infant. Amphetamines are concentrated in breast milk which causes concern about typical side effects of stimulant medications as well as withdrawal symptoms. There is no information about methylphenidate during nursing. There is too little information available about atomoxetine and modafanil to recommend their use during breastfeeding.

While we have tried to answer your question by providing information, this information should not be considered a substitute for medical advise and a women should always discuss such information with her treating physician.

Source:
CHADD website