A New Lens on Pharmacotherapy for ADHD in Pregnancy

CONFERENCE REPORTER

“This is the hottest topic in ADHD,” said Greg Mattingly, MD, of the day’s first session topic at the American Professional Society for ADHD and Other Related Disorders conference. Attention deficit hyperactive disorder (ADHD) and pregnancy has been much discussed, with clinicians considering effects of altering ADHD pharmacotherapy on both mothers and their developing children. Presenters Allison Baker, MD, and Katherine Bang-Madsen, PhD, showcased the risk-risk analysis strategy that may be most beneficial for clinicians helping patients decide whether to continue medication into pregnancy.¹

Baker began the session, highlighting how ADHD symptoms can become more challenging to manage during and after pregnancy, and many women have a desire to continue their medication after becoming pregnant. In the perinatal period, there are a range of treatments that are nonpharmacological, but some patients may still need their medication for daily functioning. These patients should consider continuing their medication through pregnancy, Baker recommended. Though, for more mild to moderate cases, clinicians can provide psychoeducation, cognitive behavioral therapy, dialectical behavioral therapy, and mindfulness exercises. Baker emphasized that clinicians should not jump to discontinue pharmacotherapy for ADHD immediately when a patient becomes pregnant. A study “highlighted that the decision, very strictly, of discontinuing medication may roughen ADHD symptoms, specifically functional impairment, as well as be a vulnerability factor for mood symptom roughening,” Baker said.^1,2 Clinicians must consider the balance of risks and benefits for continuation vs discontinuation, Baker advocated.

Baker characterized postpartum as a “high stress and low control period” for the mother. With the period surrounding pregnancy being a particularly vulnerable time, women with ADHD may experience heightened symptoms and increased burden. Postpartum, ADHD symptom burden can increase the most, especially with the mother’s self-concept declining and functional impairments increasing. The risk of going untreated during pregnancy can be high for the mother, but the risk to the development of the child should be weighed as well.

Clinicians must be aware that automatic discontinuation of ADHD medication in pregnancy does pose a meaningful risk, Baker explained. While many patients may choose to limit medication exposure during pregnancy, the postpartum period can also then be an opportunity to optimize medication dosage. Ultimately, treatment decisions should be individualized and incorporate a collaborative risk-risk analysis between the clinician and patient, Baker concluded.

Katherine Bang-Madsen, PhD, continued the conversation, incorporating recent research on ADHD and pregnancy. She posed the essential questions that patients are asking:

• If I continue my medication, what could happen to the baby?
• If I stop my medication, what could happen to me?

Concerns cited about potential impact of stimulants often include congenital malformations, increased blood pressure or vascular tone, increased risk of miscarriage in already vulnerable pregnancies, and complications like preterm birth.¹

There has been a general increase in ADHD medication use during pregnancy in the last decade, but we still lack randomized controlled trials in this area, Madsen outlined. Madsen emphasized that studies on ADHD medication and pregnancy show mixed data and are not definitive. The estimate of medication effect on pregnancy is highly sensitive to study design, she pointed out. With a lack of randomized controlled trials, we must interpret carefully and consider issues with confounding and ascertainment bias.

A recent observational study showed no increased risk for congenital malformation in pregnancy with amphetamines, but an increased risk with methylphenidate.³ Though the effects were small, methylphenidate was found to be related a possible small increase in child cardiac malformation.³ Some papers have outlined hypertensive disorder complications with continuation of ADHD medication through pregnancy, and Madsen noted this as the biologically most plausible effect of the medication, though the effect is likely modest.^4-6 Another population-based registry study on preterm birth found that medication exposure may modestly increase preterm risk—particularly with longer or continued use—but the study cannot determine definitive causality.⁷ In terms of neurodevelopmental outcomes for the child, Madsen described recent studies as having a “reassuring pattern.” Across 4 studies noted, there was no signal fond of increased long term neurodevelopmental condition risk when mothers continued ADHD medication.^8-11 These studies included useful sensitivity analysis like sibling-controlled design and fathers as negative controlled, Madsen pointed out.

Looking at long-term growth trajectories, Madsen provided data from a Danish registry cohort study not yet published which looked at outcomes in child height and weight from age 0 to 15 years. The study followed children of mothers who continued their ADHD medication (methylphenidate or lisdexamphetamine) through pregnancy compared with mothers who discontinued medication. Analysis excluded children who went on to start their own ADHD medication in childhood. The study showed that there may be a small effect on height trajectory with prenatal stimulant exposure, and the pattern is compatible with sex-modified vulnerability. This pattern still requires replication, Madsen noted.

The mother’s mental health is also an important factor in considering risks and benefits of continuing ADHD medication in pregnancy, Madsen highlighted. A pattern has emerged of women discontinuing medication for pregnancy, and then not returning to their medication postpartum—even though, as Baker mentioned, postpartum can be a time of worsened ADHD symptoms. Women with ADHD were found to have elevated baseline risk of perinatal depression and anxiety, and data suggested some women deteriorate in mood or functioning when they discontinue medication during pregnancy. However, discontinuation showed no increase in overall perinatal depression and anxiety.

Both presenters concluded that a risk-risk analysis, rather than a risk-no risk analysis is essential when deciding with patients whether to continue ADHD medication into pregnancy.

References

1. Baker AS, Madsen KB. ADHD and Pregnancy. Conference Proceedings of the American Professional Society for ADHD and Related Disorders. January 2026;15-18. San Diego, CA.

2. Baker AS, Wales R, Noe O, et al. The course of ADHD during pregnancy. J Atten Disord. 2022;26(2):143-148.

3. Huybrechts KF, Bröms G, Christensen LB, et al. Association between methylphenidate and amphetamine use in pregnancy and risk of congenital malformations: a cohort study from the international pregnancy safety study consortium. JAMA Psychiatry. 2018;75(2):167-175.

4. Scoten O, Tabi K, Paquette V, et al. Attention-deficit/hyperactivity disorder in pregnancy and the postpartum period. Am J Obstet Gynecol. 2024;231(1):19-35.

5. Srinivas C, Karlstad Ø, Stigum H, et al. Attention-deficit/hyperactivity disorder medication use in pregnancy and risk of preterm birth: a population-based cohort study. Paediatr Perinat Epidemiol. Published online May 14, 2025.

6. Winther M. Exploring the association between maternal ADHD and obstetric complications: a Danish population-based register study. 2025.

7. Bang Madsen K, Larsson H, Skoglund C, et al. In utero exposure to methylphenidate, amphetamines and atomoxetine and offspring neurodevelopmental disorders - a population-based cohort study and meta-analysis. Mol Psychiatry. 2025;30(9):3885-3894.

8. Dorani F, Bijlenga D, Beekman ATF, van Someren EJW, Kooij JJS. Prevalence of hormone-related mood disorder symptoms in women with ADHD. J Psychiatr Res. 2021;133:10-15.

9. Andersson A, Garcia-Argibay M, Viktorin A, et al. Depression and anxiety disorders during the postpartum period in women diagnosed with attention deficit hyperactivity disorder. J Affect Disord. 2023;325:817-823.

10. Johnson D, Wade M, Marini F, et al. Associations between self-reported ADHD symptoms and depression and anxiety in mothers and fathers during the postpartum period: A Canadian nationwide longitudinal study. J Affect Disord. 2025;378:211-219.

11. Tan, et al. Postpartum depression in women with ADHD: evaluating prevalence and medication use during pregnancy. In preparation.