Is it safe for a woman with ADHD
to receive stimulant medication treatment when she is pregnant or breastfeeding?
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With more women being diagnosed and treated for ADHD, the question whether stimulant medications during pregnancy are safe for the developing fetus has become more critical to answer with good data. In general, stimulants (either the amphetamines like Adderall or methylphenidate 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 (by not receiving medication treatment) outweighs the risk to the fetus.
The safety of stimulant medication for the fetus is difficult to know because most of the research has been done in animals. Very few human studies have been done. In animals, birth defects and behavioral changes have been found in several different species treated with high doses of methylphenidate or amphetamines.
A 2005 U.S. government expert panel evaluating the safety of methylphenidate concluded there are insufficient data to draw conclusions on 1) an association between methylphenidate therapy in pregnant women and pregnancy loss and 2) possible reproductive effects of methylphenidate in humans.(Golub et al., 2005b) A related expert panel expressed more concern about the safety of amphetamines.(Golub et al., 2005a). They concluded "there is some concern for developmental effects, specifically for potential neurobehavioral alterations, from prenatal amphetamine exposure in humans both in therapeutic and nontherapeutic settings."
A reference book, Drugs in Pregnancy and Lactation, ninth edition, summarized the literature by categorizing methylphenidate as: "Limited human data, - Animal data suggest moderate risk." Breastfeeding- limited human data- potential toxicity. "(Briggs et al., 2011)
This same text categorized amphetamines as "Human and animal data suggest risk." For Breastfeeding- the authors classified amphetamines as "Limited human data- potential toxicity."(Briggs et al., 2011) The American Academy of Pediatrics classifies Amphetamines as contraindicated during pregnancy because of potential irritability and poor sleeping patterns for the infant.(American Academy of Pediatrics Committee On, 2001)
Some important questions for a woman being treated for ADHD who is thinking about getting pregnant or who is pregnant are:
- Should she discontinue stimulants prior to becoming pregnant?
- Should she discontinue medication during the first trimester of pregnancy?
- Should she discontinue medication during the entire pregnancy?
- What are the risks both to the mother and the baby if her ADHD goes untreated?
- Are there psychosocial treatments for ADHD that do not include medication treatment that might be helpful?
- Each woman should consider all of the available information and discuss these issues with her physician and make her own decision about her treatment during her pregnancy.