A few months ago, I shared a post in which I revealed I’m planning to continue taking my ADHD medications even if and when I someday get pregnant. I explained that I literally wouldn’t be able to afford to stop taking my daily dose of CNS stimulants; sans pills, I can barely function, which means I would be unable to work (or even drive to work, for that matter). In short, I would have to risk exposing my unborn child to all manner of adverse health outcomes in utero.
As it turns out, however, such exposure may be far less likely than originally thought. As reported in a Nov. 29 ADDitude article, “The risks associated with taking an ADHD stimulant medication during pregnancy are real, but quite small,” according to an extensive population-based study published last month in the journal Obstetrics & Gynecology.
In the study, the authors examined a cohort of pregnant women “and their liveborn neonates” enrolled in Medicaid from 2000 to 2010. They compared women who took Adderall or Ritalin alone in the first half of pregnancy to unexposed women, and women who continued to take the medication past 20 weeks’ gestation to women who discontinued.
Psychostimulant use during pregnancy was associated with a small increased relative risk of preeclampsia and preterm birth. The absolute increases in risks are small and, thus, women with significant ADHD should not be counseled to suspend their ADHD treatment based on these findings.
This is an indisputably significant development in the field of ADHD research. Until now, studies of methylphenidate (Ritalin) use during pregnancy were based on cases “not representative of the general adult ADHD population having methylphenidate as monotherapy during pregnancy,” according to a 2014 systematic review published in the British Journal of Clinical Pharmacology. That is because “all the articles reported combinations of methylphenidate with either known teratogenic drugs or drugs of abuse.”
But this new revelation is equally noteworthy for what it represents. In the past, discussions of whether women should discontinue their ADHD medication during pregnancy were cloaked in foreboding language, declaring it should only be done “if the potential benefits to the mother outweigh the potential risks to the fetus.” To me, it seems inevitable any woman faced with such tacit guilt-tripping would opt to go off her daily pill regimen — to, in short, prioritize the safety of her unborn child over her own well-being.
Also, this new knowledge has given me a newfound sense of legitimacy. While I’m an ardent feminist, I can’t deny that in Western society, motherhood is held up as the quintessential state of womanhood. So when years ago I found out having ADHD may mean I could not become a mother — at least, not if I wanted to continue to receive treatment for it — I felt like an essential part of myself was forcibly eroded. It was as though I was no longer a real, full-fledged woman because I probably wouldn’t be able to have a baby. And it wouldn’t be for a legitimate reason, like income or infertility; it would, like so many other things, be dictated by my need to take medication, to engage in preemptive damage control of my disability. In essence, it would have meant a disability I had from birth would prevent me from giving birth, myself. And when that dawned on me, one thought repeatedly ran through my mind: “It’s not fair.”
I don’t know if I’ll ever end up having a baby. As I said in my earlier post, because of the strong likelihood my offspring would have ADHD as well, I would only want to bring a child of mine into this world if I knew it were a world more tolerant of ADHD than the one in which I grew up. Plus, I couldn’t handle single parenthood, and I don’t know what the future holds for me vis-à-vis finding a life partner.
But with the publication of this study, for the first time in my life, I know if circumstances do align for me, I’ll be able to do what I’ve always wanted — become a mother — without stigma and without the overwhelming fear of putting my baby at risk in the process.
That’s an invaluable gift.