I’ve always wanted to be a mom. I have an objectively kick-ass mother, so I have an excellent model to emulate. I have a weird knack for relating to the tiny humans of the world, so communication wouldn’t be a problem. And I have ADHD, so I’m intimately familiar with the vulnerability, the lack of being taken seriously that all children experience to some degree. And it would just be a ton of fun: getting to trick-or-treat again…teaching your offspring the subtler points of swinging on a swing set…BABY CLOTHES…need I continue?!
…ANYWAY, ever since my diagnosis about 23 years ago, I’ve been on some form of methylphenidate, which is one of two go-to pharmacological treatments for ADHD, the other one being amphetamine (aka Adderall). The medication I take now, dexmethylphenidate (aka Focalin) is technically a different drug, but medically, dexmethylphenidate is basically just a more potent form of regular methylphenidate.
Over time, two antidepressants (Effexor and Forfivo) and one non-stimulant (Intuniv) have joined the party that is my ongoing ADHD treatment regimen. Be that as it may, stimulants aren’t just the first-line recommended pharmacological treatment, but the square-one treatment altogether — beating out behavioral therapy and other non-chemical methods — because they’re the most effective. So, yeah, Focalin: kind of a big deal for me.
One problem, though: You’re not supposed to take CNS stimulant medications if you’re pregnant. Well, let me rephrase that. You may continue to take these medications, but in the words of Dr. Patricia Quinn, “the prevailing recommendation is that stimulants should be used during pregnancy only when the potential benefits to the mother outweigh any risk to the fetus.”
What are the potential risks?
This is from the drug label information for Adderall:
There are no adequate and well-controlled studies in pregnant women. There has been one report of severe congenital bony deformity, tracheo-esophageal fistula, and anal atresia (vater association) in a baby born to a woman who took dextroamphetamine sulfate (a form of amphetamine) with lovastatin during the first trimester of pregnancy.
By contrast, according to an article from a 2013 issue of Basic & Clinical Pharmacology & Toxicology, “Methylphenidate exposure during pregnancy does not appear to be associated with a substantially (i.e. more than twofold) increased risk of congenital malformations.”
Even so, unfortunately, in an article published in the journal Drug Safety in 2014, its abstract states, “[T]here is recent evidence that the rates of fetal loss both through abortion and through miscarriage are increased with methylphenidate.”
I’ve also read of lower Apgar scores, reduced birthweight, and heart problems.
So why ignore the risks?
We live in a capitalist society. So even if I stay single and childless all my life, I’ll still need to support myself financially. Translation: I’ll need to be gainfully employed. And sans medication, I lack the concentration even to start brushing my teeth. (I say ‘start,’ because if your ADHD is severe enough, you don’t have to worry about getting distracted — because you can’t even start concentrating in the first place. Yes, I am speaking from personal experience.)
Medications for ADHD are Pregnancy Class C; i.e., you shouldn’t take medication while pregnant because it could expose your unborn child to birth defects and long-term medical issues. However, according to another 2014 article, published in the British Journal of Clinical Pharmacology, “Although the default medical position is to interrupt any non-essential pharmacological treatment during pregnancy and lactation, in ADHD this may present a significant risk.”
The ‘significant risk’ in question could be an adverse reaction to having one’s medication dosage lowered or cut altogether, i.e., withdrawal. But trust me, danger also lurks in the decision to put an unmedicated pregnant woman with ADHD behind the wheel.
Consider the following passage from a recent Washington Post article on the subject:
Christina Wichman, associate professor of psychiatry and obstetrics and gynecology at the Medical College of Wisconsin, says that pregnant women with milder ADHD symptoms can go off meds and ‘do quite well.’ But she also makes the very real point that ‘there are other women with more severe symptoms which interfere significantly with their daily functioning, including ability to work, go to school or impact their relationships, and may potentially affect their pregnancy.’
Ironically, according to the abstract of a 2008 article published in the Journal of Psychiatry & Neuroscience,
Children with ADHD whose mothers were exposed to moderate and severe stress during pregnancy tend to develop more severe symptoms than children with ADHD whose mothers were not exposed to prenatal stress. It is therefore important to minimize stress in pregnant women.
All of this is to say that I would take the risk because not doing so would pose a greater one. And yes, those would be my only options, because I’m determined to be able to have a baby. My ADHD has affected me in so many ways: I didn’t find true friends till I was 15; didn’t get my license till I was almost 18; didn’t have my first kiss till I was 21; the list goes on and on. But with this, I’m not going to let my ADHD stand in my way. In matters of maternity, my disability will not be my destiny.
A new world = a new baby
If I do become a mom, it would most likely happen sometime in the next 10 years. When I contemplate this reality, what gives me greatest pause isn’t biological, but sociological in nature. Kids with ADHD are four times more likely to have a relative with it. And, of course, if a child of mine has ADHD, I would want them to spend their childhood (and their adulthood, for that matter) never feeling misunderstood or looked down upon for their ADHD symptoms. Nobody ever talks about the inherent dangers of being born, in any discernible way, different. But I will only bring a child into this world if and when I know they would grow up in one more accepting of ADHD and more open-minded about people who have it — a world not of hate and prejudice, but love and tolerance.
Won’t you create this world with me?