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Treatment in Psychiatry   |    
ADHD and Pregnancy
Marlene P. Freeman, M.D.
Am J Psychiatry 2014;171:723-728. doi:10.1176/appi.ajp.2013.13050680
View Author and Article Information

Dr. Freeman has received research support from or served on advisory boards or as a consultant for Forest, GlaxoSmithKline, Lilly, Otsuka/Lundbeck, Pamlab, and Takeda and has served as a medical editor for DSM Nutritional Products.

From the Department of Psychiatry, Harvard Medical School, Boston; and the Perinatal and Reproductive Psychiatry Program, Massachusetts General Hospital, Boston.

Address correspondence to Dr. Freeman (mfreeman@partners.org).

Copyright © 2014 by the American Psychiatric Association

Received May 24, 2013; Revised July 18, 2013; Accepted August 05, 2013.

Abstract

Attention deficit hyperactivity disorder (ADHD) has been increasingly recognized and treated in children and adults in recent years. As a result, a growing number of women enter their reproductive years treated with medication for ADHD or are diagnosed and start medication during their reproductive years. A common question in perinatal psychiatry regards the risk-benefit profile of pharmacotherapy for ADHD, particularly with stimulants. At this time, there are no guidelines to inform the treatment of ADHD across pregnancy and the postpartum period. Concerns about in utero exposure to stimulants are based primarily on the impact these medications might have on fetal growth. While stimulants do not appear to be associated with major congenital malformations, more human data regarding potential behavioral teratogenicity are needed in order to understand both the short- and long-term risks. Severity of illness, presence of comorbid disorders, and degree of impairment have an impact on treatment decisions. Crucial considerations include driving safety and ability to function in occupational roles. While most women can successfully avoid the use of stimulant medication during pregnancy, there are cases in which the benefits of stimulant treatment outweigh known and putative risks of in utero medication exposure.

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