Some thoughts on Adderall in pregnancy

***Disclaimer: Not Medical Advice***


I've spent quite a bit of time contemplating the usage of my ADHD drugs now and continuing on into my pregnancy. I had a less than stellar experience speaking with my PCP's nurse the other day that left me in tears, and I've decided it was time to do my own research on the situation.

As a bit of a backstory: I was diagnosed with ADHD as an adult after my husband brought my symptoms to my attention. I have always been a high achiever, but quite the "dreamer" and often left tasks unfinished. Retrospectively, the writing was on the wall. But I made it through grammar school as the day was so regimented. When I experienced the freedom of college, I fell flat on my face. I fully attribute my DH pointing out my symptoms to the success I experienced in the latter half of my college career.


I came across a great article from the Massachusetts General Hospital, and I wanted to share some of the highlights:

"Available data on the therapeutic use of Amphetamine in pregnancy shows no increase in the risk of congenital malformations"
(Milkovich, 1977- Effects of antenatal exposure to anorectic drugs) 

"A large cohort study monitoring 50,282 women with medication exposure during pregnancy (including 367 women taking Dextroamphetamine and 215 unspecified Amphetamines in the first trimester) demonstrated no increase in the risk of malformation in exposed infants"
(Golub, 2005- NTP CERHR Expert Panel Report on the reproductive adn developmental toxicity of amphetamien and methamphetamine) 

Conclusion: Available data for Amphetamines suggest no increase in the risk of malformation when used at therapeutic doses, while infants might have slightly lower birth weights.

(http://www.womensmentalhealth.org/clinical-update-use-of-stimulant-medications-in-pregnancy/)


Another quote I came across (and I forgot to save the source) sums up why Adderall is a Category C drug in pregnancy:

"To date, the effects of stimulants during pregnancy have only been studied in animals, where defects were seen in the offspring when the mothers were given very high doses of the stimulants. The doses of stimulants given to animals for these studies have been 41x and 12x the usual human dose. The literature contains individual case reports of women who have taken stimulants during their pregnancy and, clinically, there have been many other women who have taken stimulants and have had normal babies." 


The "usual human dose" is 60-120mg/day. Even before TTC, my dose was only 30mg, and I've already stepped down to 20mg/day. I know that in the past, anything less than 20mg has not been helpful to me. 

There have also been some correlational studies showing that children born to women who took amphetamines during pregnancy had lower school performance, however these studies did not take into account the genetic predisposition to ADHD and other sensory-processing-disorders and failed to exclude children based on those criteria  To me, it would be just as likely to have a low-performer in school due to undiagnosed ADHD.

DH and I have decided, based on the research, that it is in my best interest to continue my adderall at this time, and to re-evaluate how I'm feeling once I get my BFP. Currently I only take my meds on weekdays, and occasionally on the weekends if we have much to accomplish. I'd continue that trend in pregnancy, with taking a drug holiday every weekend.

Ideally I'd like to abstain from adderall during weeks 6-10 (during primary brain formation) and again from weeks 27-30 (when most of the rapid brain development occurs). I'm also hoping to be fully off adderall by week 37 to give Future Fetus Dreamer time to process through any remaining adderall in the system to hopefully avoid any withdrawal symptoms after birth.

Weighing risk vs. benefit is no fun, but maternal stress can be as detrimental to fetal development as drugs, and in my case the stress that comes with being the "scatterbrained dreamer" while not medicated could easily cause more harm than a micro dose of adderall.

My biggest concern is not the affects of the adderall on the fetus, but the effects of adderall on my blood pressure. I've been running high the past few months (130s/70s) and my blood pressure is *much* lower when not on stimulants (in the 90s/60s range). Part of the increase is related to my weight gain, but if my BP begins to spike in pregnancy, I'll have to learn to cope without the stimulants.