By Beth Kiernan, MPH, Interviewer and Teratogen Information Specialist, MotherToBaby
Kristin called MotherToBaby one afternoon saying, “I just took a home pregnancy test and it’s positive.” Christine sounded beyond worried. “I’ve been on an ADHD drug since I was eight and when I looked online it said it was harmful and I should stop taking it before I got pregnant.” Christine had not planned to get pregnant. Now, not only was she afraid of harming her unborn child, but it was impossible to think about stopping the medication for a very good reason: “I’m a Cardiac Intensive Care Unit nurse in a hospital – staying focused is critical to my patients’ lives.”
Kristin is not alone in her concerns.
This is one of the most common topics about people contacting MotherToBaby, which is not surprising. About 1.4 million people in the US have been diagnosed with Attention Deficit Disorder (ADD) or Attention Deficit Hyperactivity Disorder (ADHD). Given that nearly half of all pregnancies in the US are unplanned, her situation is not unusual.
ADD and ADHD are chronic conditions often diagnosed in childhood. They cannot be cured, but can be managed with counseling/behavioral guidance, medication, or both. If you or someone you know is affected by ADD/ADHD, you know that there are some classic things that can be challenging, such as difficulty staying organized at home and at school or work, trouble sleeping, being distracted, acting without thinking things through, having trouble behaving properly, having trouble completing tasks, being short tempered, talking a lot, sometimes feeling anxious or restless.
About 60%-80% of children diagnosed with ADD/ADHD will need to take their medication into adulthood, as it often helps them with everyday life. But what happens when a woman with ADD/ADHD gets pregnant? This was Kristin’s concern and Dr. Google (searching the internet for pregnancy medication advice) is not the recommended solution! Luckily for Kristin, that’s our specialty here at MotherToBaby. We talk to women about all their medication choices and concerns, drawing on key research to educate them. This gives them the information they need to discuss their drug options with their healthcare providers.
Christine was on Ritalin.
Ritalin is a stimulant drug also called methylphenidate. Kristin’s concern reflects the fact that Ritalin is grouped with other stimulants like amphetamines and methamphetamine, so it can be difficult to untangle the research when it’s all lumped together in discussions of pregnancy. Obviously, drugs used in an addictive way like “meth” or “speed” are not recommended in pregnancy because research has shown negative effects, such as pregnancy complications and postnatal problems with behavior, emotions, memory, attention and development. However, taking a prescribed daily dose of methylphenidate or other ADD/ADHD medications during pregnancy has not been shown to increase the risks of having a baby with a birth defect. Nor have we seen an increased risk for pregnancy complications such as preterm birth or low birth weight. In addition, babies exposed to prescription levels of methylphenidate in utero that were studied up to one year of age had normal development.
I told Kristin that, for people like her with ADD/ADHD, methylphenidate can really promote success at work, school, and getting along well with other people. Stopping this drug can cause problems, so it’s good to know that the data we have on its effects on pregnancy is reassuring.
Other side effects of ADD/ADHD medications in a pregnancy.
I also shared with Kristin some information about pregnancy: sometimes people on methylphenidate feel less hungry and when combined with pregnancy this can lead to weight loss. Likewise, changes in the body during pregnancy may mean that the prescribed daily dose level may need to be changed periodically during pregnancy to adequately treat ADD/ADHD. Finally, stimulants can affect heart rate and blood pressure. I told Kristin that if she had any of these problems while she was pregnant, she should call her health care provider. And I added that if she still feels nervous about taking her meds, that maybe her doctors could help her find other ways to manage her ADHD.
Still worried, Kristin asked if her baby could be born addicted to Ritalin. I explained to her that sometimes babies exposed to stimulants before birth have shown withdrawal symptoms after birth. When babies have this condition, they may have trouble eating, they may sleep too little or too much, they may have very floppy or stiff muscles, or they may be nervous. These usually disappear within 1-2 weeks and there are no permanent effects. Babies who have more severe symptoms may need to stay in the hospital a little longer to receive treatment. However, we would not expect this level of withdrawal to occur with regular use of methylphenidate taken as prescribed. In addition, it is difficult to predict whether withdrawal symptoms will occur. It occurs more often when women take opioids and other drugs for mental illness and epilepsy. With daily doses of methylphenidate, her baby is likely to have mild or no symptoms, even if Kristin needed to take it until delivery.
What about breastfeeding?
Finally, Kristin said that while she hadn’t planned on getting pregnant, she was excited about it and hoped to breastfeed as she had heard that was best for her baby. She asked if she could continue to take her Ritalin and breastfeed her baby. I told her that small amounts of methylphenidate have been found in breast milk studies, but that the levels are so low that you wouldn’t expect them to cause problems. Normal sleep and feeding have been reported in exposed infants. I suggested she talk to her pediatrician about it as well once she found one in her insurance network.
In the end, Kristin told me that she felt very relieved that she fully understood her condition and that she could more accurately understand the potential risks to her pregnancy versus the benefits to her of maintaining her medication. Now she can “focus” on preparing for the next chapter of her life: impending motherhood!
Beth Kiernan, MPH, is a Teratogen Information Specialist at MotherToBaby Pregnancy Studies, a nonprofit organization that conducts observational research on pregnancy exposures and provides information to health care providers and the general public about drugs and others during pregnancy and breastfeeding. She is based at the University of California, San Diego and is a married mother of four.
About MotherToBaby
MotherToBaby is a service of the Organization for Special Teratology Information (OTIS), a recommended resource from many agencies, including the Centers for Disease Control and Prevention (CDC). If you have questions about exposures, such as medications to treat ADHD/ADHD, during pregnancy and breastfeeding, call MotherToBaby TOLL FREE at 866-626-6847 or try the new MotherToBaby text information service by sending questions to (855) 999-3525. You can also visit MotherToBaby.org to browse a library of newsletters about dozens of viruses, drugs, vaccines, alcohol, diseases or other exposures during pregnancy and breastfeeding, or connect to all of our resources by downloading the new free MotherToBaby app, available at Android and iOS markets.
