Allie, 26, had been on medication for attention deficit hyperactivity disorder (ADHD) since age eight. When she learned that she was pregnant, she decided to stop taking the ADHD stimulant drug.
She stayed off ADHD medication for the remaining seven months of pregnancy, and for the next year as she nursed her baby. There were consequences. She had trouble focusing and almost lost her job.
Her impulsivity resulted in major conflicts with her husband, family, and friends. When her baby was six months old, Allie’s mother told her she shouldn’t come over for Thanksgiving dinner.
“She told me I needed to rest,” says Allie. “It hurt, but it’s true. I feel like I’m crazy all over again. I can’t sit still. I interrupt everyone.” She added, with tears, “Everyone I need cannot stand being around me.”
Allie had good reasons to stop her meds. She didn’t want to take the chance that ADHD medication might hurt her baby. “I know it’s unlikely. But I could never live with myself if I did,” she says.
We came up with a plan to manage the changes in her mood and behavior so she could make it through the final six months of nursing. It included asking for support and understanding from friends and family, and working with her non-ADD spouse to build more structure into their lives.
A Difficult Decision
When a woman with ADHD plans to become pregnant or learns that she is pregnant, she must decide, like Allie, whether to remain on medication. If she chooses to nurse her child, this is a decision that will affect her — and those around her — for up to two years. Two years of being ADHD all over again. What to do?
The first step is to discuss your concerns about medication with your obstetrician and your future pediatrician. You also need to talk about the options with your spouse/partner.
Complicating this decision is the fact that there are no clear-cut studies showing that stimulant medication is either safe or unsafe. There is no ethical way to do a study, giving medication or a placebo to a population of pregnant or nursing women, and then collecting data on the outcome for the babies. We don’t yet have the necessary data to make an objective decision.
The stimulant medications used to treat ADHD can be found in the FDA’s Category C (see “Drug Safety: Know Your Risk,” sidebar) for pregnancy. For nursing, ADHD medications are classified as L3: Moderately Safe (“There are no controlled studies in breastfeeding women, however the risk of untoward effects to a breastfed infant is possible. Drugs should be given only if the potential benefit justifies the potential risk to the infant”) in the most commonly used safety scale.
As you can see, there are no clear guidelines, and professional advice varies. Some experts suggest that you stay off medication for the first month of pregnancy, others specify the first trimester, when critical brain development takes place. Still others recommend waiting until the third trimester. If you decide to take medication, use the short-acting forms during crucial times, which minimize how long the medication remains in your system.
Concerning lactation, many health professionals believe that the risks associated with not breastfeeding may outweigh the risks of using stimulants. The American Academy of Pediatrics recommends that women breastfeed their babies for at least one year.
If you decide to resume medication after giving birth, however, doctors recommend waiting until your baby is a few weeks or a month old, and eats less frequently.
While breastfeeding, you should use short-acting meds, which peak and leave the system relatively quickly. Thus, you can time your baby’s feeding schedule to nurse just before you take a dose. There is no easy answer. You, your doctors, and your partner must weigh all the information and make the decision you feel best about.
The No-Meds Route
If you decide to stop taking ADHD medication, educate everyone who needs to know — husband or partner, other children, extended family, employer. Remember that they may not have seen you as hyperactive, inattentive, and/or impulsive for a long time, or ever.
Explain that you are stopping medication because you feel it’s best for your baby, and welcome any support they can offer — bringing over some meals, reminding you of appointments. You may also want to consider decreasing or eliminating certain responsibilities.
When you feel overwhelmed, rub your tummy or snuggle with your baby and remind yourself of why you decided to be ADHD all over again. Good luck!