We Demand Attention on the Safety and Efficacy of ADHD Medication Use During Pregnancy and While Nursing

What We Know

New research suggests that continued ADHD medication use during pregnancy carries few maternal or fetal risks, however most women do not treat their ADHD symptoms with medication while pregnant.

Women who continue dexamphetamine use throughout pregnancy experience no elevated risk of adverse neonatal or maternal health outcomes, compared to those who cease ADHD medication use during pregnancy. This groundbreaking conclusion of a March 2024 study¹ including 1,488 pregnant people reinforced the findings of an even larger Swedish study published in 2023.

That research, which followed 898 children exposed to ADHD medication in utero, found that such exposure does not impair a child’s neurodevelopment or physical growth. “These findings provide reassurance for women with ADHD who depend on ADHD medication for daily functioning and who consider continuing medication in pregnancy,” the study concluded.

Still, just 2.45% of ADDitude readers who have been pregnant said they used ADHD medication during pregnancy, according to a survey of 1,180 such women. Many of these survey respondents said they remained unmedicated during pregnancy not due to fears or medical advice, but because they weren’t yet diagnosed with ADHD.

Without ADHD medication to ease symptoms during pregnancy, life felt unbearable for many women. “I wasn’t diagnosed until age 49,” wrote one 53-year-old woman in Australia. “The first trimester of my pregnancy was awful. I could not control my reactions or emotions and it’s fair to say that, in hindsight, it was the worst time for ADHD issues I can recall in my life.”

More than three-quarters of the women surveyed by ADDitude said their ADHD symptoms stayed the same or worsened during pregnancy — and nearly all were unmedicated during this time. Of the 29 survey respondents who continued taking ADHD medication during pregnancy, most reported achieving successful symptom management that improved their quality of life.

“During my first pregnancy, I came off my medications cold turkey after being on them for 24 years. I do NOT recommend this strategy,” wrote a woman diagnosed with ADHD at age 8. “I nearly lost my job during that time. I was more anxious/worried, and I couldn’t complete even the simplest tasks. My symptoms did not change like this during my second and third pregnancies because I was able to continue taking my medication.”

“I consulted my doctor, and we decided the benefits outweighed the risks” of continued medication use during pregnancy, wrote a 33-year-old reader in North Carolina.

According to a November 2022 study of 45,737 pregnant females with ADHD, medication use during pregnancy may be protective against a host of adverse outcomes.² The study found that pregnant individuals with ADHD who were unmedicated were significantly more likely than their non-ADHD counterparts to experience depressive episodes, postpartum depression, hyperemesis gravidarum (extreme, persistent nausea), eclampsia (seizures in pregnant people with preeclampsia), gestational hypertension, and cardiac disease, among 10 other adverse health outcomes. Women with ADHD who took ADHD medication during pregnancy saw those risks fall across the board. Women who took stimulant medication saw the biggest risk reductions in preterm births and anemia, while women taking non-stimulants saw the greatest risk reductions in renal disease, malnutrition, and gestational diabetes.

“Women with moderate-to-severe ADHD should not necessarily be counseled to suspend their ADHD treatment [during pregnancy] based on these findings,” wrote the study authors. “Untreated ADHD can lead to negative outcomes for both mother and infant. Studies have shown that pregnant women with ADHD may have greater difficulty with managing obstetric appointments, which may increase the risk of negative health outcomes of undiagnosed and unmonitored complications such as preeclampsia and gestational diabetes… Given the highly correlative nature of ADHD and other mental health conditions, one must consider comorbidities of untreated ADHD. Left untreated during pregnancy, individuals with ADHD might be at increased risk of depression, feelings of isolation, and familial conflict.”

A 2020 study found that women who discontinued stimulant medication use during pregnancy experienced a significant increase in postnatal depression, despite remaining on their antidepressant medication. They also suffered significant impairment in family functioning.³ Meanwhile, a large Swedish cohort study with sibling analysis recently found that taking acetaminophen (Tylenol) during pregnancy was not associated with the development of autism or ADHD in babies.⁴

What We Don’t Know

Though 99% of women with ADHD report at least one comorbid condition, no research exists on the safety and efficacy of multimodal treatment for ADHD, depression, and/or anxiety during pregnancy, or the relative benefits and risks of each medication class.

We rely largely on anecdotal evidence today to argue that unmedicated ADHD symptoms cause significant psychological and neurocognitive distress during pregnancy, and that these impairments are more severe than those experienced by pregnant women without ADHD. A 2014 study concluded that, “It is possible that women with preexisting ADHD constitute a vulnerable subgroup for neurocognitive worsening during pregnancy,” however, scant research exists to prove or disprove this theory. Are women with ADHD who suspend treatment during pregnancy more likely to experience job loss, relationship problems, and mental health crises? The 2022 study titled “Obstetric Complications in Mothers with ADHD” shows that depression risk is 2 to 3 times higher for this cohort; however, we’re left making educated guesses about most other maternal outcomes.

That 2022 study was among the first to demonstrate the positive outcomes associated with medication use during pregnancy for women with ADHD, and to confirm the low risk of poor fetal outcomes from maternal medication use. However, the study authors acknowledge that they “did not examine many other comorbid conditions, such as depression, anxiety, or substance use, which may have impacted the results.” In a 2022 ADDitude survey of 5,230 women with ADHD, 73% said they had anxiety, 63% said they experienced depression, 23% said they had PTSD or c-PTSD, and 22% said they suffered migraines. Comorbidities are the rule with ADHD, not the exception.

Future research on pregnant people with ADHD must take into consideration comorbid conditions and aim to answer questions such as these:

• How do the hormonal changes during each trimester of pregnancy specifically impact symptoms of hyperactive/impulsive vs. inattentive ADHD?
• Why do some women experience heightened or aggravated ADHD symptoms during pregnancy, while others experience more mild ADHD symptoms during pregnancy?
• Is there a correlation between the dosage of ADHD medication used during pregnancy and maternal or fetal outcomes? If so, what is the relationship?
• How do the risks of adverse fetal outcomes differ, if at all, with use of prescribed methylphenidate vs. amphetamine vs. a non-stimulant medication during pregnancy? While nursing?
• Are the medications less commonly prescribed for ADHD — such as bupropion, atomoxetine, viloxazine, clonidine, and guanfacine — safe to use during pregnancy?
• Is it safe to use ADHD medications in conjunction with antidepressant medications, such as serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and tricyclic antidepressants (TCAs), during pregnancy? Similarly, is it safe to treat both ADHD and anxiety during pregnancy?
• What are the relative risks and benefits of ADHD medication use vs. antidepressant use or anti-anxiety medication use for pregnant women with these conditions?
• What are the long-term mental health outcomes for women with ADHD who are medicated during pregnancy and while nursing, vs. those who are not medicated during those critical periods?

The list of questions could stretch on regarding ADHD symptoms, treatment, and outcomes during and after pregnancy, but answers to the above would significantly impact many women’s lives.

Why It Matters

Without research findings to provide a clear understanding of the benefits and risks associated with ADHD medication use during pregnancy, many women fearful of adverse outcomes will discontinue medication use, only to suffer a range of difficulties that can make day-to-day life nearly intolerable. Research studies to clarify these questions will guide more informed, effective treatment decisions and improve the mental and physical health outcomes for many neurodivergent patients.

The fact is that roughly 97% of women with ADHD receive no ADHD treatment during pregnancy, resulting in serious and sometimes fatal health consequences. Improving our understanding of ADHD medication safety and efficacy during pregnancy stands to reduce risks of everything from depression to preterm birth and gestational diabetes in women with the condition. This can save women’s lives and improve the lives of their family members as well.

The maternal mortality rate in the United States – 32.9 deaths per 100,000 live births overall and 69.9 deaths per 100,000 live births among Black women — has nearly doubled since 2017. The U.S. maternal mortality rate is 10 times that of Norway and four times that of the European Union. Why aren’t we doing everything in our power to keep women safe and healthy during and after pregnancy?

A Related Consideration

Young women with ADHD are about four times more likely than their neurotypical peers to experience an unwanted pregnancy before age 30,⁵ according to research conducted, in part, by Stephen Hinshaw, Ph.D., principal investigator of the ongoing Berkeley Girls with ADHD Longitudinal Study.

“By the time they reached their mid to late 20s, about 43% of the BGALS participants in the ADHD group had one or more unplanned pregnancies compared to about 10% of individuals in the comparison group,” said Hinshaw, who noted that girls and women with ADHD face higher risk for an array of negative outcomes including higher rates of depression and anxiety, intimate partner victimization, and risky sexual behaviors.

What if, armed with significant research regarding the symptoms of ADHD in young women, obstetricians partnered with primary care doctors or neurocognitive specialists to screen patients with unplanned pregnancies for ADHD? We know from the ADDitude survey of 1,180 women with ADHD that few knew they had ADHD when they were pregnant and, therefore, they did not receive the healthcare they needed to avoid the adverse health outcomes common during and after pregnancy. Screening this population of patients for ADHD would significantly improve outcomes for women during a time of heightened symptoms and physical and psychological stress, especially if evaluations were paired with reliable data and medical advice about medication use during pregnancy.

What ADDitude Readers Tell Us

Patients who work closely with their healthcare providers to devise ADHD treatment plans and monitor vital signs while using medication during pregnancy achieve consistently good outcomes, while those who cease medication outright sometimes suffer symptoms that impair their professional and personal lives.

“Working memory issues were obvious throughout pregnancy,” said a 33-year-old health care provider in Wisconsin who stopped taking Adderall while pregnant. “I would forget what I was going to say once it was my turn to talk with my patients. My impulsivity was the worst in the first trimester; I was constantly eating out of boredom.”

“I saw a special OBGYN who frequently monitored my and my baby’s health,” wrote a 35-year-old in Illinois. “I continued to take 5 mg Adderall two times a day as well as a mood stabilizer.”

“I actually feel like the greater purpose of caring for my health because there was another human involved helped me stay committed to better habits that mitigate symptoms,” said a reader. “I was also seen by a special OBGYN so that I could stay on a low dose of my mental health medications, which I’m sure worked better in combination with consistently making positive lifestyle changes.”

“During pregnancy, I was off my medication, so my life was like it was before the diagnosis and starting medication,” said a 50-year-old reader in Maryland. “Thankfully, I was busy working and getting ready for the baby. Being busy always helps me.”

What ADHD Experts Say

“The new demands of caring for their babies during a time of changing hormone levels, infant feedings, and sleep disruption are exceedingly difficult for some women,” wrote Allison S. Baker, M.D., in the ADDitude article “Treating for Two: ADHD Meds in Pregnancy.” “Being an effective mother requires the ability to get and stay focused, modulate attention, control impulsivity, and utilize executive function skills. Women with ADHD struggle in these domains, yet this population and the course of their condition during pregnancy and the postpartum period have received little attention and systematic study.”

Next Steps

Write to the White House Initiative on Women’s Health Research ([email protected]) to request funding for research dedicated to understanding how ADHD treatment during pregnancy may significantly improve both maternal and fetal health outcomes.

Related Reading

• Postpartum Care for Mothers with ADHD: A Guide for Clinicians
• Treating for Two: ADHD Meds in Pregnancy
• Study: Prenatal Exposure to ADHD Medication Does Not Impact Neurodevelopment
• Study: Discontinuing Stimulant Medication Negatively Impacts Pregnant Women with ADHD

We Demand Attention: A Call for Greater Research on ADHD in Women

Intro: Top 10 Research Priorities

1. Sex Difference in ADHD
2. The Health Consequences of Delayed ADHD Diagnoses on Women
3. How Hormonal Changes Impact ADHD Symptoms in Women
4. How Perimenopause and Menopause Impact ADHD Symptoms, and Vice Versa
5. The Elevated Risk for PMDD and PPD Among Women with ADHD
6. The Safety and Efficacy of ADHD Medication Use During Pregnancy and While Nursing
7. How ADHD Medication Adjustments During the Monthly Menstrual Cycle Could Improve Outcomes for Women
8. The Long-Term and Short-Term Implications of Hormonal Birth Control and Hormone-Replacement Therapy Use Among Women with ADHD
9. How and Why Comorbid Conditions Like Anxiety, Depression, and Eating Disorders Uniquely Impact Women with ADHD
10. Early Indicators of Self-Harm, Partner Violence, and Substance Abuse Among Girls and Women with ADHD

ADDitude is dedicated to honoring gender diversity and fluidity. For the purposes of this reporting, we use the terms “girls” and “women” to refer to individuals assigned female at birth and/or who identify as female.

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