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.

So now that basically everyone in my office knows...

IF meds are a fickle fickle thing. I've been falling asleep EARLY (for me) every night, waking up multiple times a night to pee, and generally have been exhausted.

I'm supposed to be working an event for work tomorrow night that the "new girl" is orchestrating. She's been here for 2 months, and I've probably had less than 5 conversations with her (she works in a different service unit).

Today I had to explain to her that I might have to duck out of the event early because my fertility meds are making me exhausted. So now officially everyone in the department knows that not only are we TTC, but we're going through IF treatments. I work in a fairly spiritual environment so it's nice to know that my coworkers are praying/sending good vibes, but at the same time it's a bit awkward. 

Since I have no cell reception in my office, every call to or from the RE goes through my desk phone, so those in the offices/cubes near me have a general idea of what's going on... but I just feel so exposed right now.

I'm fortunate to work in a field (social services/community building) where motherhood is celebrated and being "open" about our intentions to start a family is not a reason to withhold projects or promotions, but rather to provide opportunities for growth. Several employees in my unit have had complicated pregnancies and it's the type of office where they do a take-a-meal sign up, where there are always baby showers, and where a bedrest work-from-home plan is always a possibility. 

I *don't* plan to be a SAHM after LO #1. It's just not who I am. I crave adult interaction, and my biggest reservation about getting married was becoming "Mr. X's Wife" vs NariaDreaming. In the same way, I can't imagine being identified primarily as "Junior's Mom". Not knocking SAHM's in any way- my mom was a SAHM for 10 years- it's just not something I see in my future. And my boss knows it. 

So here's to being "out" at work! 

Caffeine withdrawal

So today starts day # 1 of my caffeine detox. I'm surrounded by caffeine addicts at work. On any given day at work I normally have a diet soda and 4-5 cups of coffee. I know I'm going to have to cut *waaaaaaaaay* down when pregnant, so I figured I'd give it up cold turkey starting now.


This is how I feel



Luckily caffeine was the only major vice I have that I need to kick- I can count on two hands the number of times I've been to a bar in my life, and I don't smoke. Now if I can just figure out what to do about this pesky ADHD medication I'd be smooth sailing.

But in good news, I woke up with some twinges around my left ovary. I'm just so glad it's not my bum right ovary feeling productive right now- which makes me want to do this



Welcome to CD8 where everything is magic and wonderful

Hot flashes and a realization that it's really here

So since I'm in a complaining mood, I just need to vent about these hot flashes. I'm not sure what's worse, wanting to strip naked at work, or wanting to just take my laptop to the ladies' room so that I don't keep getting interrupted by my bladder.


On a more... uplifiting(?) note it hit me today- we're actually freaking cycling. In 20 days we could be pregnant.


And this fills me with equal parts excitement and dread. Due to the progesterone, I did not lose as much weight on my "break" as I had hoped, and I'm starting out this journey in the "obese" category. I know that bigger gals successfully carry pregnancies every single day, but this is *not* where I wanted to be. But with the hyperplasia issues, I'm not willing to take time off of meds to lose weight pre-pregnancy.

And then there's the ADHD issue. I was diagnosed with ADHD during college, and I'm terrified what life without my meds would look like at work. There is NO way I would be productive for 9 months while pregnant and unmedicated. I'm comfortable with the risks to the future fetus based on the med I am on, but DH is on the fence.

And then there is the cutting down my coffee habit.

So many changes that may occur in the next few weeks, God willing.

Just call me Seabiscuit

Oh. My. WORD.

I cannot stop urinating! This is getting ridiculous. I don't know what it is about the Clomid, but I've been peeing (and peeing a good volume) EVERY SINGLE DAY since starting it. Can't even temp since I'm up 3 or 4 times to relieve myself.


Make.it.stop.now

goin' off the rails on a crazy train.......

Pretty sure that there's some sort of diagnosis or medication for what I'm currently feeling. 

There is nothing, and I mean straight up NOTHING that could have prepared me for the Clomid mood swings. Give me back the damn provera right now because those mood swings looked absolutely childlike compared to the mood swings I've had over the past 24 hours. 

Because my life honestly feels like this

Today, DH could do no right, I spent a solid 4 hours yelling at him for everything he's ever done to upset me, and alternated this hot ass mess with hysterical sobbing. It's almost 10PM, I haven't showered, gotten dressed, or brushed my hair.

Apparently "mental health days" are occasionally an OK thing, but I feel like a fat, lazy, disgusting slob. I have VERY oily skin, and as such my cell phone screen gets quite dirty. DH asked "what happened to your phone" which launched me into another 45 minute cry fest about how I'm just a disgusting, slovenly pig who isn't worthy of love and affection 

I'm assuming at this point you're all like

And honestly, I wouldn't blame you one bit.... because I'm completely off my rocker right now. And honestly, I just want to do something like this with every electronic device in my house, and lay here in complete and utter solitude

Three.More.Days of this devil medication. Between freaking out about OHSS and dealing with these side effects.... well, I hope we get our BFP this cycle because I can't imagine what level of psychobitch I will achieve if we have to do injects.

Back from a long hiatus and here WITH A PLAN!

I feel like such a blogging slacker, but for the past few months we've just been in a holding pattern waiting for the provera, and then the megace, to do their thing and clear up the hyperplasia.

We had our first RE consult in early July, and it went well. He's the one who switched me over to Megace. The good news is that I cried less on the Megace and wasn't nearly as depressed. The bad news is that it made me an angry, angry bitch.

Had a repeat biopsy at the end of July- and NO evidence of hyperplasia. I think I've officially beat this monster. So then it was time to get the ball rolling.


Which brings us to yesterday- the day of my HSG. Oh where to even begin. There's nothing delicate or fun about it- though it wasn't nearly as bad as I was expecting. I did take 800 of ibuprofen and 2 tylenol before the procedure- which seems to have helped.

There are no ways to adequately describe the experience known as the HSG. It felt like someone backed a cement truck up to my cervix and then dumped their load up my uterus.

But it was over fairly quickly. Except for the part where they couldn't get a good visual on my right tube. The rad. tech was in another room controlling the table and x-ray, so all I heard was this voice from the ceiling telling me to "pop my hips, oblique toward the door, oblique away from the door, ok, back down"

The good news: My uterus and left tube were picture perfect
The bad news: My right tube was completely occluded- probably a parting gift from an ex-douchebag of mine.

So after a round of 10:30 AM drinks I headed to the office feeling rather deflated.


And then my RE's office called. They had my clomid script ready. They just wanted to know if I'd be starting it THAT NIGHT or today so they could schedule my follie-check ultrasound.


Wait, WHAT? We're starting to cycle today? As in right now?

My day went from this 

To this

To this

and finally something like this

So happy CD 3 to me!!!!!!