Millions of women are prescribed Adderall XR for attention deficit hyperactivity disorder in the U.S. If you are one of them, and have ever had a conversation with your doctor about coming off birth control, you will know that it may be strongly advised to discontinue the stimulant medication.
Untreated ADHD, Adderall withdrawal symptoms and a baby brain may seem too much to handle, however your ultimate goal is to protect your pregnancy.
So, what do you do? This article aims to provide you with some helpful facts and information.
Key Takeaways: Adderall and Pregnancy
- Adderall XR has been a first line intervention for treating ADHD since 2002. Increasingly, women with ADHD are becoming pregnant on Adderall.
- Seek professional medical advice if you take ADHD medications and are pregnant.
- Potential risks, such as a lower birth weight and premature birth, could affect your pregnancy if you continue to take the ADHD medicine.
- The exact risk of long term adverse outcomes to the baby, such as abnormalities and neurological impairments is not known due to lack of data on pregnant women taking stimulants.
- Moderate symptoms of ADHD may be treated with alternatives to Adderall, but pregnant women with severe ADHD symptoms may be advised to continue the medication regardless.
What Is Adderall?
Adderall is a stimulant medication that is prescribed by psychiatrists, supporting patients to manage ADHD symptoms. Attention deficit hyperactivity disorder (ADHD) is a behavioral disorder characterized by inattention, a lack of ability to focus, impulsive behaviour and hyperactivity. It can lead to difficulties managing day-to-day tasks [1].
Adderal’s key benefit is that, at therapeutic doses, it dramatically increases the ability to focus and concentrate. That is why it has a big impact on treating behavioral health conditions like ADHD.
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How Does Adderall Work?
Adderall works by stimulating the nervous system and altering chemicals in the brain. It affects neurotransmitters, particularly the ones in the brain’s reward center that are sensitive to the reward hormone dopamine. When dopamine receptors are triggered by a drug, they increase our feeling of motivation, satisfaction and help us focus better.
Amphetamines, via the nervous system, speed up the messages that travel between the brain and the body. The physiological boost enhances energy and wakefulness. They also affect the cardiovascular system, increasing the heart rate and raising blood pressure. The rise in blood pressure is due to constriction of blood vessels, which is another bodily effect of Adderall.
Adderall and Pregnancy: Is It Safe?
The safety of taking Adderall during pregnancy is not confirmed. If taken as prescribed, there is little evidence to show the relationship between Adderall and neonatal outcomes.
That said, safety for you and your baby during pregnancy is paramount. Here we provide you a summary of available scientific evidence, information and possible side effects of using Adderall during pregnancy.
Adderall Effects on Fetus: What Could Happen?
The main possible adverse outcomes of Adderall use during pregnancy are:
- Reduced birth weight
- Birth defects
- Congenital malformations
- Premature delivery
1. Reduced Birth Weight
Evidence from a large study of pregnant women including some who took dextroamphetamine (Adderall XR) showed that infants born of mothers taking the drug had a 4% lower birth weight than those not taking the drug.
The relationship was apparent especially when women continued using the drug after 28 weeks gestation, which is a high weight gain trimester for the baby. The reason for the lower birth rate is likely due to Adderall’s role in constricting blood vessels, which during pregnancy reduces the amount of blood and oxygen that can pass through the placenta [2].
2. Birth Defects
In some analyses, there are three birth defects linked to Adderall use during pregnancy. They are:
- Gastroschisis, which is when the baby’s intestines grow outside of the baby’s body from an opening next to the belly button.
- Omphalocele is when the baby’s intestines, liver, or other organs stick outside of the belly or belly button, because the abdominal wall didn’t form properly.
- Upper and lower limb reduction, when the top of the fetus’ arm or leg does not form properly and the affected limbs are reduced in size [3].
The exact causes of these abnormalities are still unknown, but it is thought that exposure to Adderall in early pregnancy might contribute to the risk.
3. Congenital Malformations, also known as heart problems
There is a potential link between cardiac malformations and ADHD medications.
Two large studies in the US and Europe analyzing over four million pregnancies total revealed that there was a minor increased risk of cardiac malfunctions in babies with mothers taking ADHD medications.
The results showed that with other ADHD medications, such as Ritalin (methylphenidate), there was a “potential small increased risk of cardiac malfunctions” in the babies. The data shows that Adderall did not have a significant effect, but there is discussion between health professionals that more research is needed on this [4].
4. Premature Delivery
Amphetamines can stimulate uterine contractions, which increases the risk that you deliver prematurely. The Federal Drug Administration (FDA) notes this is their guidance about the risks of Adderall for pregnant women taking stimulants [5].
Common Side Effects of Adderall During Pregnancy
Common side effects of Adderall to watch out for during pregnancy:
- Loss of appetite
- High blood pressure
- Dependency
1. Loss of Appetite
An adverse maternal health effect from taking Adderall is its impact on appetite. Women who are administered Adderall may be eating less than women who are not, at a time when diet is highly important. The nutrition of the mother and health of the fetus could be affected. This is a factor to consider in light of possible reduction in the baby’s birth weight.
2. High Blood Pressure
Pregnant women are more vulnerable to high blood pressure and the consequences of it are more serious when pregnant. Anyone with pre-existing health conditions, especially hypertension, will likely not be given Adderall at all. Blood pressure should always be monitored regularly during pregnancy, particularly if you are taking Adderall.
3. Dependency
Adderall can be very addictive, which means that it is often abused. Adderall abuse during pregnancy may mean that your baby becomes physically dependent on it too. Babies born with a dependency to amphetamines can have difficulty feeding, seem irritable or agitated, and are very drowsy [5].
The effect on babies who have ingested high levels of stimulants in the womb due to drug abuse is often irreversible [6].
If you or people around you believe Adderall dependency is an issue for you and your baby, there are substance abuse programs that aim to provide impartial support and counseling, and may be able to help you find a treatment center.
Statistical Risks: Can You Take Adderall While Pregnant Or Not?
The exact level of risk to expectant mothers taking Adderall and their babies is not known. In the general population, there is already a chance that pregnancies will be miscarried or develop major birth defects (15–20% and 2–4% respectively).
Also the percentage of pregnant women who suffer from ADHD is quite low: 3.2%. There is insufficient risk data about pregnant women taking stimulant medication [5].
Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4313616/
From available epidemiologic reports and data, the highest risks of adverse pregnancy outcomes from taking Adderall are premature delivery and low birth weight. However, miscarriage and birth defects may not be more likely than in the general population, or with those not taking stimulant medications, according to the FDA [5].
Human studies are also lacking due to ethical considerations. Animal studies show more dramatic birth defects and high rates of fetal morbidity, but have largely been experiments with high doses of drugs, which are not representative of prescribed amounts in humans.
Licensed medical professionals may want to err on the side of caution, as the lack of available data is unnerving. There are obstetric risks with Adderall use and pregnancy, which your qualified healthcare provider will try to avoid. There is also little long term data on brain development of the infants born to mothers who take the medication during pregnancies [7].
Despite this, part of the risk assessment that your healthcare professional will carry out is weighing up the risk of exposure vs the risk of being unmedicated. If your doctor believes, for example, that discontinuing the medication will leave you at serious risk of crashing your car because of ADHD symptoms, this could outweigh the potentially smaller chance you will have complications during your pregnancy [8].
Coping With ADHD and Pregnancy: What To Do
Expecting mothers managing ADHD symptoms may find all of this information a lot to take in, understandably. If ADHD affects you and you are pregnant, here’s what you can do to cope:
Follow Your Doctor’s Recommendations
Your doctor will be able to make a more objective assessment of what to do. Based on the severity of behavioral health conditions they can establish whether the benefits outweigh the risks of continuing with Adderall during your pregnancy.
If you have a severe case of ADHD that interferes with your ability to take care of yourself, your doctor might suggest it is safer to stay on the drugs to help you focus on you and your baby.
Think about steps to take after you have had the baby. Who will support you during your postpartum period? How will you reach your follow up appointments? Discuss with your doctor the signs and symptoms of postpartum depression and what to do if you experience it.
It is not advisable to immediately discontinue taking stimulant medication when you discover you are pregnant. Pregnancy combined with a possible Adderall crash may be problematic for you and your mental health.
If you have already decided you want to stop taking Adderall because you are concerned about how it might impact your baby, you and a medical professional can discuss a way to taper off the stimulant medication safely.
When you have stopped the medication, it might benefit you to look at alternative treatment options that help with relaxation and focus.
Alternative Treatments
Increasing dopamine levels in the brain is the main effect of Adderall and other stimulant medications. There are simple natural ways to do the same; albeit without such an immediate impact. These techniques may also help you to relax and enjoy the journey of pregnancy more.
Regular Exercise
Moderate exercise for pregnant women has many great health benefits for mother and baby. Aside from warding off some of pregnancy’s undesirable symptoms such as excessive weight gain, exercise also reduces stress and anxiety by lifting mood.
Regular exercise during pregnancy also means you may expect a shorter time in labour [9].
Therapy
Talking therapy, and cognitive behavioral therapy, can be recommended in mild cases of ADHD as an alternative to medication.
Your therapist might give you some tips on how better to organize yourself without the artificial focus of stimulant medications, such as writing things down so as not to forget them.
Massage Therapy
Massage is a great thing to treat yourself to during pregnancy. As your body goes through its incredible transformation, aches and pains are commonplace.
Indulging in self care activities like these are great ways of increasing your dopamine levels and other hormones that help you maintain a relaxed, happy mood during pregnancy.
Meditation
Meditation is known to be relaxing and focuses concentration. It reduces stress, lowers blood pressure and can affect areas of the brain conducive to memory and learning.
For these reasons, it is highly recommended during pregnancy, as well as to treat mild to moderate anxiety or depression.
Tricyclic Antidepressants
Tricyclic antidepressants are a category of antidepressants that were used originally to treat a mental health disorder called Major Depressive Disorder (MDD) and are now FDA approved for a variety of psychiatric problems. It could be that your doctor recommends you change medication, as opposed to stopping it altogether.
As with Adderall, the added risk of certain birth defects and miscarriage from taking anti depressents during pregancy is undetermined. However, there is some evidence suggesting that prenatal exposure to some types may increase the risk of heart defects.
On the other hand, nortriptyline, a type of tricyclic antidepressant, appears to be a safer medication for nursing mothers, as it is less likely to affect breast milk [10].
Adderall and Fertility
There are no available scientific studies to assess the relationship between Adderall and fertility. However, it does not appear to be an issue for fertility in humans.
Adult ADHD is more prevalent now than ever before. Many women carry the disorder over with them from childhood; some people are even being diagnosed in adulthood. As such, ADHD medication use before and during pregnancy has increased dramatically over time.
Can You Get Pregnant While on Adderall?
Yes, and given the high rate of unplanned pregnancies among young women, there is an increase in women with ADHD who are getting pregnant on Adderall, as well as fetuses exposed to the drug in the first trimester. Health professional groups say this under-researched phenomenon warrants further analysis.
FAQ
Let’s recap some of this information and address your frequently asked questions about Adderall and pregnancy here.
Can Taking Adderall While Pregnant Cause Birth Defects?
Possibly, but studies show that women taking Adderall at recommended doses may not be more likely to have babies with birth defects than women who do not take the drug. All pregnancies come with a baseline risk of birth defects.
Does Adderall Pass Through Placenta?
Yes, and research shows it can also pass through breast milk in nursing women. That is why your health care professional should carry out a careful risk assessment if you discover you are pregnant on Adderall.
Does ADHD Medication Affect Pregnancy?
Yes, it can. Adderall has side effects that increase the chance of some obstetric risks. For example, Adderall constricts blood vessels in the body, which raises blood pressure and reduces the amount of oxygen and blood that can flow to the baby.
What Can I Take Instead of Adderall While Pregnant?
Your doctor might explore the option of alternative medications to treat ADHD with you. Less harmful alternatives like tricyclic antidepressants can be prescribed, especially for breastfeeding women.
Over the counter Adderall options could be available to you, although always check the instructions to ensure they are safe during pregnancy.
Conclusion
It’s not your fault if you have been prescribed Adderall then discover you are pregnant. However if you are pregnant and still taking Adderall, it is important that you discuss with your doctor as soon as possible what to do next. They might suggest that you lower your dose, taper off your Adderall and stop altogether, or explore different treatment strategies, depending on what is best for you and your baby.
References
- “Https://Www.psychiatry.org/Patients-Families/Adhd/What-Is-Adhd.” What Is Adhd?, www.psychiatry.org/patients-families/adhd/what-is-adhd.
- RL;, Naeye. “Maternal Use of Dextroamphetamine and Growth of the Fetus.” Pharmacology, U.S. National Library of Medicine, pubmed.ncbi.nlm.nih.gov/6844388/.
- Kayla N. Anderson, Annelise C. Dutton. “ADHD Medication Use during Pregnancy and Risk for SELECTED Birth Defects: National Birth Defects PREVENTION Study, 1998-2011 – KAYLA N. ANDERSON, Annelise C. DUTTON, Cheryl S. Broussard, Sherry L. Farr, JENNIFER n. LIND, SUSANNA N. Visser, Elizabeth C. AILES, Stuart K. Shapira, Jennita Reefhuis, SARAH C. Tinker, 2020.” SAGE Journals, journals.sagepub.com/doi/pdf/10.1177/1087054718759753.
- Krista F. Huybrechts, MS. “Congenital Malformations and Methylphenidate and Amphetamine Use in Pregnancy.” JAMA Psychiatry, JAMA Network, 1 Feb. 2018, jamanetwork.com/journals/jamapsychiatry/article-abstract/2664964.
- ADDERALL XR Label – Accessdata.fda.gov https://www.accessdata.fda.gov drugsatfda_docs PDF HIGHLIGHTS OF PRESCRIBING INFORMATION.
- JR;, Plessinger MA;Woods. “Maternal, Placental, and Fetal Pathophysiology of Cocaine Exposure during Pregnancy.” Clinical Obstetrics and Gynecology, U.S. National Library of Medicine, pubmed.ncbi.nlm.nih.gov/8513624/.
- MP;, Baker AS;Freeman. “Management of Attention Deficit Hyperactivity Disorder during Pregnancy.” Obstetrics and Gynecology Clinics of North America, U.S. National Library of Medicine, pubmed.ncbi.nlm.nih.gov/30092924/.
- MP;, Baker AS;Freeman. “Management of Attention Deficit Hyperactivity Disorder during Pregnancy.” Obstetrics and Gynecology Clinics of North America, U.S. National Library of Medicine, pubmed.ncbi.nlm.nih.gov/30092924/.
- Rodríguez-Blanque, Raquel, et al. “Physical Activity during Pregnancy and Its Influence on Delivery Time: A Randomized Clinical Trial.” PeerJ, PeerJ Inc., 7 Feb. 2019, www.ncbi.nlm.nih.gov/pmc/articles/PMC6371916/.
- S;, Gentile. “Tricyclic Antidepressants in Pregnancy and Puerperium.” Expert Opinion on Drug Safety, U.S. National Library of Medicine, pubmed.ncbi.nlm.nih.gov/24383525/.
- Golub, Mari, et al. “NTP‐CERHR Expert Panel Report on the Reproductive and Developmental Toxicity of Amphetamine and Methamphetamine.” Wiley Online Library, John Wiley & Sons, Ltd, 15 Sept. 2005, onlinelibrary.wiley.com/doi/10.1002/bdrb.20048.
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