By Maria Romaszkan
Pregnancy can be an exciting time, although not without its challenges and uncertainties. If you have ADHD, you may dread how pregnancy will influence your symptoms. If you’re on stimulant medication, you also need to decide whether to continue it during this time. We’ve asked experts to help us shed light on how ADHD and pregnancy influence each other and how you can make this time easier.
ADHD and Pregnancy
There is limited research about how ADHD affects pregnancy and vice versa, as U.S. Food and Drug Administration regulations exclude pregnant women from clinical trials.
Still, there is some evidence that pregnant women with ADHD are at a higher risk of such complications as early labor or a condition called preeclampsia, which usually begins 20 weeks into pregnancy and includes high blood pressure and signs of organ damage.
“When it comes to individuals with ADHD, pregnancy can come with unique challenges,” says Julia Poole, a women’s mental health therapist with Lemon Tree Therapy in Scottsdale, Ariz. “Hormonal changes can affect neurotransmitter levels in the brain, potentially worsening symptoms related to attention, focus, and impulse control. Coping skills and routines that worked before pregnancy may prove less effective during this season of rapid changes to one’s body, daily routines, sleep habits, relationships, and even preferences for foods and smells. These difficulties can be overwhelming, especially when added to the already commonly experienced physical and emotional demands of pregnancy.”
Still, some women say their ADHD symptoms decreased during pregnancy. This may be due to estrogen levels dramatically increasing, especially in the first trimester. Estrogen has a significant impact on dopamine, which is responsible for executive functioning and which is often low in the ADHD brain.
However, estrogen levels drop drastically after birth, which results in a quick return of ADHD symptoms. Such a jarring change can result in your mental health worsening. That may be one of the reasons why women with ADHD are more likely to have postpartum depression.
ADHD Medications During Pregnancy
Women who are taking stimulants for their ADHD might wonder whether the stimulants are safe to take during their pregnancy. The uncertain answer: Since pregnant women are excluded from clinical trials, there’s insufficient evidence to know for sure.
“There is no definite evidence that stimulants are harmful to the fetus, but I always advise women to stop their stimulants from conception to the end of pregnancy and breastfeeding,” says John Shershow, a Manhattan-based psychiatrist specializing in Adult ADHD.
Animal trials have shown that stimulants based on amphetamines or methylphenidates had shown a negative effect on the fetus. The FDA therefore considers stimulants a ‘Category C’ medication — meaning risks cannot be ruled out.
Still, a Category C label also means that the benefits of using these medications may outweigh their potential risks. This notion seems to be supported by newer research showing minimal risk of complications for women taking stimulant medication during pregnancy.
Stress and mental health decline due to stopping the medication and ADHD symptoms worsening may be more dangerous than continuing the medication, especially for women with severe ADHD symptoms.
But each case is different. And with scarce research, you must carefully weigh your options. If you’re pregnant or planning to conceive, you should definitely discuss this issue with your doctor or consult a psychiatrist with deep knowledge of ADHD and perinatal mental health. They can explain any risks and help you make an informed decision.
It’s also possible to replace stimulants with non-stimulant medication, but Shershow warns that very little is known about the effects on non-stimulant medication on the fetus.
Never adjust or stop your medication without consulting your doctor first. Going cold turkey can mean severe mental and physical side effects and possibly impact the pregnancy.
Poole suggests checking out the website of the non-profit organization Postpartum Support International, where you can find information about using psychiatric medications during pre-conception, pregnancy and postpartum. It’s also an excellent resource for medical professionals; you might recommend this website to your doctor.
“It’s worth noting that they offer a free perinatal psychiatric consultation service for prescribing medical professionals,” says Poole.
Overall Tips on Managing ADHD During Pregnancy
Whether you take medication or not, it’s good to have a toolbox of different strategies to help you manage your ADHD symptoms and keep you and your baby healthy.
Here are some tips:
• Start with the Basics
Proper diet and rest make it easier to manage ADHD symptoms and ensure you have plenty of energy to help your baby grow.
“I recommend starting with the basics, such as checking in with yourself about hydration, food intake, movement and rest,” Poole says. “Neglecting these things can lead to increased stress and fatigue, which can worsen ADHD symptoms. Setting reminders to help ensure you meet these needs or keeping a water bottle and snack readily available and within your sight can help you stay on track.”
• Get Some Exercise
Regular movement can help you release excessive energy and has many benefits for pregnancy, like reducing back pain and swelling or helping with labor. Even a daily brisk walk is a great way to stay active. There are also many fitness classes designed for pregnant women.
Still, remember to consult your doctor before starting any exercise. Your doctor will be able to help you find safe forms of physical activity and monitor for any changes in your condition.
If you have a regular workout routine, it’s good to ask a professional to help you modify it as your pregnancy progresses.
• Learn to Manage Stress
Pregnancy can be stressful, even more so if you have ADHD or must make crucial decisions requiring medication. Long-term stress can make your symptoms worse and even impact the pregnancy. Learning grounding techniques to manage stress is essential for your well-being.
“Taking a few minutes for mindfulness and self-care during the day can help manage stress and improve focus. It can look like taking a few deep breaths with your eyes closed and reminding yourself that you’re doing enough or having a spontaneous dance party to your favorite song,” says Poole. “Taking a moment to connect with your baby by gently touching or rubbing your belly while talking or singing to them can also help reduce anxiety and improve overall mood.”
• Consider Therapy
Shershow points out that coaching or therapy can be an excellent non-pharmacological way to manage ADHD symptoms during pregnancy.
A therapist or coach can help you learn to manage symptoms, be more self-compassionate and guide you through fears you may have regarding being a parent with ADHD.
Some forms of treatment are particularly effective in treating ADHD. Cognitive behavioral therapy seems espeically beneficial.
• Find a Support Group
Social support is invaluable during pregnancy. You can sign up for a support group for future moms or find a community online. It can be especially beneficial to find women who also have ADHD as they can understand your particular problems and experiences.