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A The Complete Guide To ADHD Medication And Pregnancy From Start To Finish
ADHD Medication and Pregnancy

Physicians are unable to provide accurate information regarding the security of ADHD medications during pregnancy. Until more research is available, physicians must weigh the advantages of using medication during pregnancy against the potential dangers for children in each particular situation.

A study of a population-based sample has followed 898 infants who were born to mothers who took ADHD medications during pregnancy (stimulants amphetamine methylphenidate dexamphetamine ; non-stimulants modafinil, atomoxetine, and clo), until they were diagnosed as having a developmental disorder, died or left the country.

Risk/Benefit Discussion

CAP Smart Take

Doctors are concerned with the long-term effects that exposure to drugs during pregnancy can be a source of harm, particularly for centrally stimulating drugs such as those used to treat ADHD. It is essential that women receive proper advice from their doctors regarding the dangers and benefits of taking medication during pregnancy and prior to conception. In this CAP Smart Take we look at the most current research in this area and how it might inform the practice of a physician.

Animal studies and illicit drug research suggest that stimulant medication passes to the fetus via the placenta, and could negatively affect fetal growth and development. There is however, a limited amount of data on how the fetus responds to dosages of prescribed stimulant medication during pregnancy, and most of this evidence comes from single-arm studies that have not been sufficiently powered to determine if there are significant correlations.

The study conducted by Cohen and colleagues4 is distinctive because it is the most thorough and well-controlled. The study covered 364,012 pregnancies that were retrieved from the Danish Medical Registry. Information regarding medication use was collected by analyzing the redeemed medication. The researchers specifically excluded women who reported taking SSRI medications or clonidine since these drugs can interact with the fetal NMDA receptor and increase the risk of neurodevelopmental disorders such as autism and ADHD. The authors also modified their analyses to control for potential confounding factors as well as to take into account the timing of in utero exposure.


The results of this study and other small-scale trials suggest that the vast number of women who continue to take their stimulant medications prescribed to treat ADHD during pregnancy do not experience adverse effects on their foetuses. Therefore, it is likely that a lot of pregnant women will continue to use their ADHD medication. However, it is crucial that doctors carefully evaluate the advantages and risks of these medications for pregnant patients, as well as consider each patient's unique situation prior to suggesting that they stop taking their medications. No matter what decision they make, it is vital that pregnant women suffering from ADHD inform their spouses or partners, extended family members and employers about the decision they have made. It is because the signs of hyperactivity, inattention and impulsivity are likely be re-present when the mother stops taking their medication.

Pregnancy Tests

Preconception counseling should comprise a comprehensive management program that incorporates both behavioral and medical treatment and ongoing monitoring throughout the perinatal period. The plan should include a discussion about current medication regimens, particularly during the first trimester when the risks of harming the baby because of untreated ADHD are the highest. This should be a collaborative effort with obstetrics, psychiatry and primary care.

The discussion on risk and benefits should address how a woman plans to manage her symptoms of ADHD during pregnancy, as well as the impact on family functioning and how she would feel about a decision to stop psychostimulant therapy in the early stages of the pregnancy. This should be based upon a thorough evaluation of the evidence available and be mindful of the individual needs of the patient and concerns.

The authors of a massive study that followed children who were exposed to ADHD medications while in utero concluded that "continuation psychostimulant use during the early stages of pregnancy was not associated with adverse birth outcomes and if anything, it was associated with less stress among mothers." However their conclusion isn't without a few limitations. The study did not consider the importance of the dosage of stimulant medication, nor the long it was used in addition to other factors related to sociodemographics and clinical. Additionally, there isn't any controlled research that evaluates the safety of continued psychostimulant use among nursing mothers.

While there is a lack of clear scientific data on the safety of ADHD medication during pregnancy, many doctors are aware of what the research suggests and apply the best practices while collaborating with each patient's unique needs. It is well-known, for instance that infants born to mothers taking methylphenidate in the first trimester are more likely to suffer from cardiac malformations (Cooper, et al. 2018). However, this finding is based on a tiny study that did not take into account differences in patient demographics and underlying psychiatric conditions.

In a recent survey ADDitude readers reported that they were more likely to discontinue their ADHD medication during the early stages of pregnancy than in the past. However, women who discontinued psychostimulants within the first trimester of their pregnancy experienced an increase in symptoms of depression. They also reported that they were less than able to enjoy their pregnancy and rated their families functioning as being more difficult than women who continued or increased their dosages of ADHD medication.

Work Functioning Test

The work functioning test is a vital component of the examination as it will determine if the patient is able to perform their tasks. The test is designed to assess functional limitations. It includes the use of graded material handling (lifting to various levels, pulling and pushing) and positional tolerance exercises (sitting, standing in a balancing position, walking and stooping, kneeling and crawling) along with other relevant specialized tests (hand manipulation). The test evaluator will review the results and come up with an appropriate return to work conclusion. ROC curves are used to determine the point of minimum misclassification (MIC) for both physical and general work ability and the work-functioning score for a particular problem.

The MIC is calculated according to the COnsensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist. This method divides scores for general physical abilities and work-functioning problems by answering an anchor question. This prevents any shift in metrics from biasing the average.

Driving Test

The gold standard for treating ADHD is psychostimulant medications. It improves driving safety and decreases symptoms. If not treated, severe ADHD can have serious psychosocial and financial implications.

Psychotherapeutic treatments such as cognitive behavioral therapy (CBT) and "coaching" strategies have also been shown to improve symptoms and enhance functioning. These strategies can assist women in adjusting their routines, and use their coping abilities in ways that minimize the impact of ADHD on their work and other aspects.

does adhd medication work of these aspects are important to take into account when deciding whether or not to continue with psychostimulant therapy. The most reliable data indicate, although there are some concerns about the effects of pregnancy on outcomes after in-utero exposure to stimulant medications, the risk is minimal, and the results are influenced by other medication, health care utilization as well as physical and mental health and the comorbidities. Bang Madsen K, Bliddal M, Skoglund CB, Larsson H, Munk-Olsen T, Hove Thomsen P, Bergink V. In utero exposure to attention-deficit hyperactivity disorder medication and long-term offspring outcomes.

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