Attention Deficit Hyperactivity Disorder (ADHD) is a disorder that affects a significant number of women of reproductive age. As we see more women being diagnosed and treated for ADHD, the issue of medication management during pregnancy and the postpartum period is becoming more pressing. ONE recent study by Bang Madsen and colleagues explores patterns of ADHD medication use during pregnancy and the postpartum period.
ADHD Medication Use Patterns
This population-based cohort study from Denmark examined patterns of ADHD medication use in 4,717 pregnancies in 4,052 mothers who filled at least one ADHD medication prescription between one year before pregnancy and one year postpartum. The study identified four different treatment trajectories:
- Continuers (23.3%): Women who continued ADHD medication throughout pregnancy and the postpartum period.
- Discontinuers (41.8%): Women who discontinued ADHD medication during pregnancy and the postpartum period.
- Stoppers (17.2%): Women who stopped prescribing during pregnancy but continued after delivery.
- Postpartum Initiators (17.7%): Women who initiated ADHD medication postpartum.
While almost 60% of women stopped using ADHD medication, only 17% of them restarted treatment (switchers) after giving birth.
Which women chose to continue or initiate treatment during the perinatal period?
The study found that women who continued ADHD medication during pregnancy and postpartum (continuators) differed on several sociodemographic and clinical factors from those who stopped or discontinued treatment. Continuers were older at conception, gave birth more recently, were more likely to smoke during pregnancy, and used other psychotropic medications during pregnancy. In addition, a large proportion of continuers (89.1%) used the stimulant methylphenidate, compared with 75.9 – 84.1% in the other groups. Continuers were also more likely to have switched types of ADHD medication during the study period (16.4% vs. 7.4–14.8%). These findings suggest that continuers may have more severe or difficult-to-treat disease or may have greater psychiatric morbidity.
Surprisingly, about 18% of women with ADHD were medication-free before pregnancy but chose to start treatment with an ADHD medication after delivery (primers). The authors speculate that while this group of women did not “need” ADHD medication prior to pregnancy, the challenges associated with pregnancy and the transition to motherhood may have increased the need for treatment. They also noted that nearly half of the initiates had filled an antidepressant prescription before, during, or after pregnancy, suggesting that this group of women may have greater psychiatric comorbidity.
Clinical Implications
Treatment decisions regarding the use of ADHD medications during pregnancy and the postpartum period should take into account the severity of ADHD symptoms, the presence of comorbid disorders, and the degree of impairment in daily functioning. Factors such as driving safety, professional role and ability to manage the demands of work and home life should also be considered.
For women with milder ADHD symptoms, discontinuing medication during pregnancy may be a reasonable option, but close monitoring for the development of depressive symptoms and anxiety is crucial. Women with more severe ADHD or those who require medication to function optimally may benefit from continued treatment, as the risks of untreated ADHD may outweigh the potential risks of drug exposure.
This study shows that about 60% of women with ADHD choose to stop their ADHD medication during pregnancy. While discontinuing medication makes sense in many cases, we also need to consider it risks of stopping medications during pregnancy and the postpartum period. Women with ADHD who stop their medication during pregnancy are at increased risk of experiencing higher levels of depressive symptoms and reduced family functioning, such as increased conflict, difficulty having fun as a family, and feeling isolated. In addition, a study from Sweden found that women with ADHD had a fivefold higher prevalence of postpartum depression and anxiety disorders compared to women without ADHD, regardless of other psychiatric diagnoses.
Ruta Nonacs, MD PhD
bibliographical references
Bang Madsen K, Bliddal M, Skoglund CB, Larsson H, Munk-Olsen T, Madsen MG, Hove Thomsen P, Bergink V, Srinivas C, Cohen JM, Brikell I, Liu X. Attention-Deficit Hyperactivity Disorder (ADHD) Trajectories of Medication Use Among Perinatal Women. CNS drugs. 2024 Apr;38(4):303-314.
