Why I’ll still be taking pills even if I get pregnant: a follow-up

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.

Pregnant-Woman-with-pill-in-hand

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.

The takeaway? 

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. 

Pregnant-woman-with-hands-forming-heart-shape-on-belly

Pregnancy + stress = public health’s perfect storm

From January 2015 to December 2016, I was a student in the master’s degree program in Women, Gender, and Sexuality Studies at Oregon State University. My time in grad school was instrumentally influential to me. I minored in women’s studies back in college at U of O, but when I realized that my real aspiration was to become a feminist writer, I decided that I needed a much stronger foundation in feminism as an area of study. And that turned out to be true in ways I hadn’t even anticipated: I became aware that my prior feminist education, for all its merits, had failed to incorporate discussions of women of color. But that was about to change.

Lifelong stress → premature birth

One of my primary research interests while at OSU was women’s health. As it turned out, one of the professors, Mehra Shirazi, specialized in that, and I was fortunate to take not one, but two courses from her: Global Perspectives on Women’s Health, in winter of my first year, and Race, Gender, and Health Justice, a year later. Of all the lessons I learned in her classes, one, in the form of a newsreel, has always stuck with me.

Stress during pregnancy → ADHD

WOC aren’t the only ones for whom stress can result in adverse birth outcomes for their childrenIn my last post, I mentioned that women with ADHD who experience stress during pregnancy are more likely to have children with it. Well, I was wrong. The abstract of an article published in the journal Frontiers in Psychology in 2011 states that “maternal stressful events during pregnancy significantly predicted ADHD behaviors in offspring,” i.e., stressful events for any pregnant woman, not just one with ADHD

Furthermore, said Dr. Ian Colman, who led a similar study earlier this year, “Generally speaking… the higher the stress, the higher the symptoms.”

In other words, more children are susceptible to maternal-stress-induced ADHD. And their symptoms vary in severity depending on the level of maternal stress. 

In the announcement of their study on stress in pregnant women and ADHD, University of Ottawa researchers included an infographic of so-called stress management tips and tricks, including:

Portrait of sad and frustrated pregnant woman.

Women with ADHD who experience stress during pregnancy are more likely to have children born with ADHD. (Photo source: Adobe Stock)

  1. Identify what’s behind your stress and address it right away
  2. Talk to your loved ones to help them help you
  3. Simplify your life by shortening your to-do list and learning to say no
  4. Quiet your mind through yoga and mindfulness
  5. Find time to do something you enjoy, such as hobbies or physical activity.

That’s all well and good, but it predicates on the dual notions that (a) stress is situational, and relatedly, that (b) women have the power, i.e., time and agency, to quote-unquote simplify their lives, quiet their minds, and do things they enjoy. 

First of all, it would be ideal  — I’m not saying it would be great, but it would be the best-case scenario — if all stress were indeed situational. But in fact, it’s systemic; there are sociological reasons that women find themselves in stressful situations.

For example, I think we can all agree that in general, men are more amenable to “going the extra mile” for their wives when they are serving as human incubators for their progeny. But this is temporary. Gender roles are so entrenched in our consciousness, exist so much in our understanding of the fabric of society that they’re liable to supersede sudden inclinations toward chivalry. They may wash the dishes occasionally; even assume all responsibility for helping the kids they already have with their homework, etc. — at least after coming home from the office.

But will they assume sole responsibility for cleaning all toilets in the house for the next nine months — and do so without even being asked? Let me put it this way: My dad is a proud feminist, but according to my mom, not even he went that far when I was a bun in his wife’s oven.

The salient point here is that unless a husband* assumes all extant household responsibilities, a wife has no means of wholly and entirely de-stressing. Moreover, in the most extreme versions of our regular social paradigm, women don’t even have time to find out what they enjoy, let alone actually do it. 

Women of color

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Stress resulting from everyday racism in women of color over a lifetime can result in adverse health outcomes for their children at birth. (Photo source: American Psychological Association)

In addition to this paradigm shift between husbands and wives, in order to avoid the adverse birth outcomes of which their children are at risk, WOC would need to retroactively un-experience the systemic (there’s that word again) ‘everyday racism’ they have experienced all their lives. Erasing the sexism that they were forced to endure, well, that wouldn’t hurt matters, either. Unfortunately, none of this is possible. Technically, we can’t do anything for the WOC already of childbearing age, except confer upon them the utmost respect and provide them with any prenatal care that may reduce the likelihood of pre-term delivery.

I have a vision for future generations, though, of my friends’ children growing up without the media suppressing reportage of violence against WOC in favor of the police-violence-against-the-Black-man narrative. In this vision, violence against POC — regardless of gender — isn’t even a thing. 

All in all, I agree with Dr. Michael Lu:

If we’re serious about improving birth outcomes and reducing disparities, we’ve got to start taking care of woman before pregnancy and not just talking about that one visit three months pre-conceptionally; I’m talking about when she’s a baby inside her mother’s womb, an infant, and then a child, an adolescent and really taking care of women and families across their life course.

And I agree, as well, with my former classmate in WGSS and dear friend Amber Moody:

I think it’s brilliant to frame systemic racism/sexism as a public health issue. … [T]hese systems of discrimination still exist; and the effects, which really can be traced back to colonialism and white supremacy, have been genetically embedded into our lives. And until we actually address the source of the problem, these … issues are going to continue to be passed down for generations.


*I say ‘husband’ because I was raised in and hypothetically will enter into a heterosexual family dynamic consisting of a cismale husband and a cisfemale wife. There are, of course, numerous other familial configurations; albeit I doubt very much that the same degree of gender-role pigeonholing would be present in a female-female marriage. 

Why I’ll still be taking pills even if I get pregnant (ADHD Awareness Month post #2)

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?!

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Focalin 10 mg, one of my daily medications. (Photo source: WebMD)

…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?

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ADHD is a Battlefield; Meli is an Ally.

If you’ve ever heard of ADHD (or, more likely, ADD), you’ve probably also heard that people usually get over the disorder when they grow up. But I’m going to let you in a little (horrifying) secret: Many people don’t get over ADHD, but get more ADHD when they enter adulthood. And there is a name for these people: women.

Members of the ADHD medical community have observed for decades that women seem to experience an amelioration of ADHD symptomology during pregnancy. (This is great, because physicians will tell you that you should only continue taking ADHD stimulant medication while pregnant if you feel that the benefit to you, the mother, outweighs the risk of harming your baby in utero; basically, the implication is that you’d have to be a sociopath to continue your treatment regimen if you have a bun in the oven.) However, it has also been observed that women seem to experience an exacerbation of their symptoms during menopause, and as young adults every few weeks or so.

As it turns out, studies in recent years have shown, an average woman’s mental acuity is proportional to her estrogen levels. An ADHD woman, of course, struggles with inattentiveness and lack of focus just as a baseline. Thus, she may be able to get by and even thrive during the first half of her menstrual cycle each month, thanks to medication and/or therapy of some kind. But when she hits her PMS week, her hormone levels deplete, and stay low until the end of her period, leaving her feeling out of it for virtually half of every month.

I mentioned in my last post that I’ve been empowered by acknowledging how real — and how limiting — my ADHD has always been. It became particularly acute starting around age 18, and now we know why: In a word, hormones. If I weren’t aware, or didn’t believe, that my disability has a biological foundation, I would inevitably suffer even more, because I would be left believing that the cause of my troubles were some flaw in my character, my quality as a person. I can’t adequately express how significantly my mental health has improved since I’ve learned to acknowledge my own limitations (and their neurological basis) and forgive myself for not always being able to exceed everyone’s expectations.

But that’s only half the battle. To win that battle, you need allies. I have at least 20. Let me tell you about one of them.

Me and Meli, May 8, 2015

Me and Meli, May 8, 2015

This is Meli. She and I were roommates at the University of Oregon’s Living-Learning Center residence hall during my freshman year of college. We definitely did not have a perfect roomie-roomie relationship back in 2009, but with every passing year she and I have grown closer and closer, so much so that today each of us considers the other one of her best friends. There is a lot to love about Meli: She is adorably small in stature and unabashedly nerdy; I can’t do justice to her particular syntax, but trust me, it’s completely unique and utterly hilarious. Above all, though, I love Meli because she loves — and supports — me, ADHD and all.

About two months ago, on the second Friday in May, Meli accompanied me on a trip to Newport (one of Oregon’s coastal towns) for the wedding of my friend Dana to her longtime boyfriend, Nick (Dana and Meli get along really well, which isn’t surprising, because they are both awesome), in which I was to be a bridesmaid. The members of the wedding party had all chipped in to rent a beach house for two nights. Around 10:30 p.m., after everyone had returned from the rehearsal dinner and a complimentary boat ride around Newport Bay, Dana knocked on the door of the bedroom Meli and I were sharing to inform me that in about 10 minutes we were all to congregate to go over the logistics of the wedding day. “Is that okay?” she asked. “Yes,” I deadpanned. “As long as you understand that I am heavily unmedicated and will not retain any of what you say.” Dana, of course, gracefully accepted this, she being an ADHD ally herself, though we were left wondering what to do in light of the current situation. But then, Meli chimed in and gamely offered to attend the confab as my proxy and take notes on the scheduling and my responsibilities for me to read the next day when I was medicated once again.

Now, granted, I was pretty emotional already, seeing as how I was about 15 hours away from witnessing the nuptials of two incredible people, but I almost burst into tears because of what had just happened: Rather than chiding me for being lazy, or even encouraging me to have some faith in myself, Meli simply accepted that I couldn’t handle the task at hand, and offered to do it in my stead. Why? Because she could. It was a far cry from my senior year of high school, when a girl who at the time I counted as one of my closest friends told me that I had done a good job “not saying anything stupid yesterday.”

A true ADHD ally embraces an ADHD woman for all that she endures, and for all that she is unable to endure. My friends support me when I push myself, and support me when I don’t. Meli is the epitome of an ADHD ally. I’m hanging out with her tonight, in fact.

I can’t wait.