A new study reveals it may be dangerous to stop taking a common ADHD medication part-way through pregnancy - but there may also be some benefits to stopping ahead of conception.
That flies in the face of existing recommendations, which suggest that child-bearers – mainly, women – with ADHD should stop taking the drug when they're expecting.
"ADHD is becoming more commonly diagnosed in women; consequently, more women are taking ADHD medication such as dexamphetamine during pregnancy," University of Western Australia public health researcher Dani Russell says.
"Our study investigated whether there were reasons to stop taking this medication during pregnancy."
More women are receiving a diagnosis of ADHD and being prescribed treatments than ever before, and while this has proved life-changing for many, it also reveals just how much we don't know about how ADHD – and the drugs prescribed to treat it – interact with womens' health, gynecological and obstetric issues.
Dexamphetamine (also known as dextroamphetamine, and the main ingredient in brands like Adderall and Dexedrine) is a stimulant prescribed to treat ADHD in many countries, including Australia, where the study took place.
The observational study – which analyzed a cohort of 1,688 women who gave birth in Western Australia between 2003 and 2018 – is retrospective, meaning it used data that was originally collected for other purposes. It does not examine cause and effect.
The pregnant women who participated decided independently whether to stop taking the drug, and when – information which could then be paired with records of their pregnancy outcomes to uncover any links.
The 297 women who stopped taking the medication during pregnancy, before the end of their second trimester, were 2.28 times more likely to experience threatened abortion (mild to moderate bleeding during the first 20 weeks) than those who continued throughout the pregnancy.
The researchers note that further research is needed, as the sample size was relatively small and the data lacked detail.
But such a high risk does suggest it's much safer to take ADHD medication consistently when pregnant – when considering when to stop the medication, never really is better than late.
However, people with ADHD who are planning ahead for a pregnancy might want to consider that there could be some benefits to stopping the meds, so long as it's prior to conception.
A group of 844 women with ADHD who had been taking dexamphetamine prior to pregnancy, but not during, experienced some benefits compared to women who continued to take the medication throughout.
Those benefits included lower risk of poor health outcomes during and after pregnancy, like preeclampsia, hypertension, postpartum hemorrhage, neonatal special care unit admittance, and fetal distress.
The study did not address the effects of starting dexamphetamine part-way through pregnancy.
"However, the results indicated that continuing to take dexamphetamine did not put women or their babies at increased health risks," Russell says.
Indeed, pregnancy brain seems challenging enough, without adding the scramble of unmedicated ADHD, let alone medication withdrawal. Not only that, but discontinuing treatment leaves pregnant people with ADHD at increased risk of depression, feelings of isolation, and family conflict.
ADHD medication has also been shown to reduce patients' risk-taking behaviors, and risk of injury as a result of symptoms like inattentiveness, which are important factors for a pregnant person to consider when deciding whether to cease treatment.
"Pregnancy can be a really stressful period for women with ADHD, so it is good to know that stopping their medication during pregnancy may not always be necessary," Russell says.
The research was published in Archives of Women's Mental Health.