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Risks and Benefits of Stimulant Use in the Perinatal Period

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Risks involved in the use of stimulants for the treatment of ADHD in pregnancy

  • no significant concerns for teratogenicity
  • questionable risk of miscarriage
  • increased risk of prematurity
  • some increased risk of adverse placental outcomes (preeclampsia, abruption)
  • some increased risk of NICU admission and CNS disorders (seizure, NOS), etc.
  • data are lacking on long term neurodevelopmental effects

Risk involved in the use stimulants for the treatment of ADHD during lactation

  • excreted in small amounts in breast milk
  • due to effects on dopamine, may cause decrease in breast milk production
  • data are lacking on long term neurodevelopmental effects on infants

General considerations

  • Consider decreasing by small increments weekly when trying to taper down/off
  • Long acting formulations have less potential to be abused
  • Higher doses may increase risk for psychosis, especially with the amphetamine class
  • Let patients know that long acting formulations should not be crushed, cut, or chewed

The decision about whether to prescribe stimulants during the perinatal period should be made jointly with the patient after sharing information about the risks and benefits. For a good review article and demonstration of shared decision-making, please reference this article:

  • Baker, A. S., & Freeman, M. P. (2018). Management of Attention Deficit Hyperactivity Disorder During Pregnancy. Obstetrics and Gynecology Clinics of North America, 45(3), 495–509. https://doi.org/10.1016/j.ogc.2018.04.010 
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Recommended toolkit resources

Return to Perinatal Provider Toolkit