The Risks and Benefits of ADHD Medications While Pregnant

Attention-deficit/hyperactivity disorder (ADHD) is a psychiatric illness involving persistent symptoms of inattention and or hyperactivity and impulsivity that negatively impact function. Symptoms often respond to behavioral therapy and medications, including stimulants. Although ADHD is often diagnosed during childhood, the disorder also affects adults. Over the last decade, the number of women taking medications for ADHD during pregnancy has increased. Currently, the percentage is estimated to be over 1 percent.

ADHD is a serious disorder that, if untreated, can interfere with school and employment, and increase the risk of serious health outcomes, including accidents and suicide. Nevertheless, some women opt to stop medication treatment during pregnancy out of concern for their own health and that of their fetus. Some women can tolerate discontinuing ADHD medications without serious consequences, whereas others have more difficulties. Therefore, the particular risks of stopping medication should be evaluated for each individual.

Decisions about continuing specific medications during pregnancy benefit from discussions among a woman and her healthcare providers. Some medications significantly influence fetal development, whereas others have less or no discernable effects. Decisions regarding maintaining or discontinuing ADHD drugs during pregnancy would benefit from additional information about the nature and degree of long-term risks to the fetus. A recent study by Kathrine Madsen and colleagues published in Molecular Psychiatry significantly adds to current knowledge about this subject.

These investigators identified all live-born singleton births between 1998 and 2015 in the Danish Medical Birth Registry. After excluding children with chromosomal abnormalities and missing data, their study included 1,068,073 offspring born to 628,478 mothers. Using Danish nationwide health registers, the research team followed each child until a diagnosis, death, emigration, or December 31, 2018, whichever occurred first.

The vast majority of children (1,065,905) were born to mothers who did not take ADHD medications either two years before or during pregnancy. A group of 1,837 children were born to mothers who took ADHD medication in the two years prior to their pregnancies. Of these, mothers of 1,270 children discontinued medication during pregnancy (the “discontinuation” group), whereas mothers of 567 children continued medications while pregnant (the “continuation” group). Another 331 mothers initiated ADHD medications during pregnancy (the “new user” group). The children in the continuation and new user groups were considered “exposed.”

The investigators compared the health histories of the 1,270 children in the discontinuation group with the 898 in the exposed group. They reported results for three developmental outcomes:

1. neurodevelopmental psychiatric disorders such as autism and ADHD
2. other neurodevelopmental impairments (for example, vision or hearing impairment, epilepsy, and febrile seizures)
3. growth impairment

Their data analysis demonstrated that after adjusting for demographic and psychiatric characteristics of the mothers, neurodevelopmental and growth outcomes did not differ between the children in the discontinuation and exposed groups. These data do not provide sufficient information to conclude that there are no effects of ADHD medications on the offspring; however, these negative findings should be somewhat reassuring.

Although larger than most studies to date, the authors noted that the number of exposed children was still relatively small and did not allow for an analysis based on the specific ADHD medication(s) the mothers were taking.

It is important to stress that decisions regarding the maintenance of specific medications during pregnancy should be made in consultation with healthcare providers with expertise in this topic. The possibility of harm from exposure to medications during fetal development must be weighed against the possibility of harm to both the fetus and mother if symptoms of a disorder re-emerge. The data from this paper provide valuable information regarding such discussions with women with ADHD.

This post was written by Eugene Rubin MD, Ph.D., and Charles Zorumski MD.