It's common for women to become increasingly cautious about how they treat their body during pregnancy. Stopping smoking and not drinking alcohol are two common recommended changes. The American Pregnancy Association notes that "over 1,000 babies in the U.S. die each year because their mothers smoked while pregnant" and that drinking during pregnancy can create health risks for the unborn child, some of which may be fatal.
Sometimes a pregnant woman will also decide to stop taking her attention deficit hyperactivity disorder medications -- or any other medications she may require -- during or before pregnancy, assuming that too is a healthy choice.
However, Dr. Alison G. Cahill, chief of the division of maternal fetal medicine at Washington University in St. Louis, says it's a "common misconception among expectant moms that they can't be on any medications during pregnancy."
She explains that several variables come into play, including -- but not limited to -- a woman's specific ADHD diagnosis and related functioning needs, how long the medication she's been taking has been on the market, what information exists about it and her life involvements such as personal workplace or educational requirements. "In some cases, it may just be a matter that a patient perceives her symptoms as mild and wants to come off of these meds," she says. Because there are so many variables inherent across each woman's unique situation, Cahill says it's important for a patient to seek the guidance of a doctor before becoming pregnant. Doing so will allow an open discussion about any possible risks and benefits, at which time assessments can be made based on individualized needs, she explains.
Dr. Michael Cackovic, assistant professor of maternal fetal medicine at Ohio State University's Wexner Medical Center, says halting ADHD meds may be more problematic than beneficial. He explains that while fetal health is clearly important, it's also essential to focus on the mother's health; both are obviously intertwined. Therefore, he says it's essential to remember that the mother is taking ADHD medications "for a reason -- she needs to be able to function," which these prescriptions are intended to help with. His main concern is that a pregnant woman who opts to go off of her ADHD medications, or who is told by her physician to stop taking them, could potentially become unstable and get in a car accident as a result. "That worries me the most," Cackovic says. "If she can't function like she used too, that's clearly not good."
Both Cahill and Cackovic agree that in general, it's ideal that any patient be on the lowest therapeutic dose of a medication and, if feasible, on the least amount of medications as possible. Both also note that consideration of risks and benefits are important, an area which isn't cut and dry.
Identifying Risks Can Be Challenging
The Centers for Disease Control and Prevention states that researchers "know little about the effects of taking most medications during pregnancy. This is because pregnant women are often not included in studies to determine safety of new medications before they come on the market." The CDC adds that "less than 10 percent of medications approved by the U.S. Food and Drug Administration since 1980 have enough information to determine their risk for birth defects." This statement parallels Cahill's thoughts about possible risks that may be involved when an expectant mother takes ADHD drugs; she says that while there is "growing body of literature about this specifically as it relates to ADHD," there is still "not a wealth of data about risks."
A potential downside can occur, Cackovic says, if a woman abuses these drugs, turning to them for something other than therapeutic use. "If a pregnant woman abuses ADHD meds, there could be adverse effects in fetal growth." Furthermore, there could be issues such as jittery neonatal behavior or central nervous system development problems, he says. But he stresses that this is only "associated with abuse of these meds and may not apply to therapeutic uses."
"A good rule of thumb," Cackovic says, "is to consider a physician or obstetrician's guidance, take the lowest therapeutic dose possible and understand the risks and benefits of these drugs."
Seeking out counseling before pregnancy is ideal, Cahill adds. She cites one example in which a woman may be at a point educationally or professionally in life where she's comfortable holding off on her ADHD meds for a few months before becoming pregnant. "In that case we can determine the risks and benefits to see how any change in medications worked." Sometimes it turns out that stopping medications isn't ideal, but Cahill says "at least the woman will know beforehand because she tried."
A Note on Breast-feeding
Cahill also touches on the topic of breast-feeding, saying that after the baby is born concerns about ADHD medications may still be on some mothers' minds. She says the considerations during pregnancy may be different than during breast-feeding: "Risks while pregnant concerning a developing fetus may be small in this case, whereas after the baby is born, medications may concentrate more in breast milk and dosing may then play a role."
She says all of this still points to the bigger picture that each woman's ADHD diagnosis, body and "life scenarios differs," so there is no blanket statement that can guide choices in this matter. The bottom line, she says, is that a woman is carrying a diagnosis -- whether it's ADHD, hypertension, lupus or another condition -- and it needs to be managed to meet her specific needs. "Everyone has different life scenarios," she says, reinforcing the need to have open communication with an obstetrician at the onset. "It's always best to talk realistically about the topic."
Jennifer Lea Reynolds is a Health freelancer at U.S. News. She draws on her life and career experiences, including losing 70 pounds and writing copy at health-centric advertising agencies. Her articles have been published online in Smithsonian, Reader's Digest, Woman's Day and The Huffington Post. She's also the owner of FlabbyRoad.com, where she writes about weight loss, fitness, nutrition and body image. You can follow her on Twitter @JenSunshine.