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THE SAFETY OF ADDERALL XR DURING PREGNANCY OR BREASTFEEDING

The information provided below is for readers based in the United States of America. Readers outside of the United States of America should seek the information from local sources.

THIS MEDICATION CAN CAUSE HARM TO YOUR BABY:

Adderall XR should only be used during pregnancy if it is medically necessary and if the benefits to the expecting mom outweigh the potential risks to the baby. There is very little data on the safety of Adderall XR during pregnancy, but there have been reports of birth defects with amphetamine use in pregnancy. Moms who are taking Adderall XR should not breastfeed.

What is Adderall XR?

Adderall XR is used to treat attention deficit hyperactivity disorder (ADHD). Adderall XR capsules contain a mix of amphetamine and dextroamphetamine salts. Amphetamine and dextroamphetamine are called central nervous system stimulants. They increase attention, alertness, energy, and make you feel more awake. Adderall XR is an extended-release version of Adderall, meaning that the effects of the medication last longer. Adderall XR only needs to be taken once daily; it should be taken in the morning with or without food. This medication should not be taken in the late afternoon or evening because it can keep you awake through the night. Adderall XR is only available by prescription from your doctor.

What is Adderall XR used to treat?

Adderall XR is used to treat ADHD in adults and children over the age of 6. ADHD is a brain disorder characterized by inattention (disorganization and difficulty focusing), impulsive behaviors (acting or speaking without thinking), and/or hyperactive behaviors (restlessness and constant movement). Without proper identification and treatment, many people with ADHD struggle academically, at work, or socially. You can read more about ADHD during pregnancy here.

How does Adderall XR work?

Adderall XR affects certain chemicals in your brain to promote wakefulness and alertness. It is unknown how the actions of these chemicals improve the symptoms of ADHD.  Adderall XR helps people with ADHD focus on tasks, control behavioral problems, maintain attention, and improve listening skills. Central nervous system stimulants, such as Adderall XR, speed up your mental processing, but they also speed up processes throughout the rest of your body. This can cause side effects such as increased blood pressure, faster heart rate, and reduced appetite. Stimulants can also cause nervousness, anxiety, and difficulty sleeping. They can be dangerous unless used under the guidance of your doctor.

If I am taking Adderall XR, can it harm my baby?

The FDA indicates that Adderall XR should be used during pregnancy only if the benefits to the expecting mom outweigh the potential risks to the baby. There is little evidence on the safety of amphetamines during pregnancy, but  there have been some reports of birth defects with their use. For some expecting moms, discontinuing ADHD medications can increase the risk of motor vehicle accidents and impairments at school or work. In these cases, your doctor may decide that Adderall XR is medically necessary.

Evidence: A recent study from the Centers for Disease Control (CDC) analyzed data from 64 expecting moms who took any ADHD medication during pregnancy. Women who took an ADHD medication early in pregnancy were more likely to have babies born with limb defects and two types of birth defects where the baby’s intestines and/or other organs are found outside the body (gastroschisis and omphalocele). It is important to note that this study did not separate the results based on the specific ADHD medication that the expecting moms took. Therefore, some moms may have taken ADHD medications other than amphetamine/dextroamphetamine (the main ingredients in Adderall XR). Of the 64 expecting moms who were studied, 39.8% took a medication containing amphetamine/dextroamphetamine. 

Another recent study looked at 1,813,894 pregnancies in the United States and compared women who were taking methylphenidate (another ADHD medication) or amphetamines to women who were not. The study found that moms who took amphetamines had an overall increased rate of birth defects and a higher rate of birth defects in the baby’s heart. However, after adjusting for various factors (such as demographics and other psychiatric illnesses the moms may have had), the study found that this increased rate of birth defects was no longer applicable and that amphetamines did not have a higher risk for birth defects.

There have been other case reports indicating that amphetamines may have been linked to birth defects and some reports that have linked amphetamines to gastroschisis. Another study found that taking amphetamines for weight loss (a purpose that Adderall XR is not indicated to treat) during pregnancy did not increase the overall risk for birth defects, but it was associated with a higher rate of oral clefts (birth defects involving the baby’s mouth).

There is still little evidence on the safety of amphetamine/dextroamphetamine during pregnancy when taken for ADHD. Although some experts consider the medical use of amphetamines to be relatively low risk to the baby, the safety of these medications during pregnancy is still largely unknown. Pregnant women should never abuse amphetamines (illegal use of amphetamines or using amphetamines for a purpose other than what is recommended by your doctor). Studies have found that abuse of amphetamines during pregnancy is linked to low birth weight, prematurity, birth defects, and health problems in both moms and babies.

Bottom Line: Adderall XR should only be used during pregnancy if medically necessary and if the benefits of treatment for the mom outweigh potential risks to the baby. There is very little data available on the safety of Adderall XR during pregnancy. There have been some case reports of birth defects and other health problems in babies whose mom took amphetamines during pregnancy. Although some experts consider the medical use of Adderall XR to be relatively low risk, the safety of these medications is still largely unknown. 

If I am taking Adderall XR and become pregnant, what should I do?

If you are taking Adderall XR and become pregnant, you should contact your doctor immediately. Your doctor will determine if Adderall XR is medically necessary for your treatment, or if it should be discontinued until after the birth of your baby.

If I am taking Adderall XR, can I safely breastfeed my baby?

The FDA warns that moms who are taking Adderall XR should refrain from breastfeeding. The American Academy of Pediatrics has indicated that the use of amphetamines is contraindicated, meaning they should never be used, because they cause irritability and poor sleep in breastfed babies. Some experts also advise that the medical use of amphetamines for the treatment of ADHD should be stopped during breastfeeding. Amphetamines, like Adderall XR, pass into breast milk in large amounts. Amphetamine has also been found in a nursing baby’s urine, meaning that the baby was exposed to the medication. No side effects were reported in the baby from exposure to amphetamines. A study that analyzed 103 nursing babies whose moms used amphetamines while breastfeeding found no behavioral side effects or sleep problems in breastfed babies.

Bottom Line: Moms who are taking Adderall XR should not breastfeed. Amphetamines can cause irritability and sleep loss in the breastfed baby. These medications also pass into breast milk in high amounts.

If I am taking Adderall XR, will it be more difficult to get pregnant?

There have been no studies looking at the effects of Adderall XR on fertility. However, this medication changes the amounts of certain chemicals in your brain. The effects of these chemicals can influence your reproductive hormones, which may affect fertility.

If I am taking Adderall XR, what should I know?

Adderall XR should only be used during pregnancy if the benefits to the expecting mom outweigh potential risks to the baby. Some studies and reports have indicated that there may be a higher
risk of birth defects with some ADHD medications, including Adderall XR.

Moms who are taking Adderall XR should not breastfeed. Amphetamines pass into breast milk in large amounts and can cause irritability and disrupted sleep in breastfed babies. Your doctor will determine if Adderall XR can be discontinued or if breastfeeding should be discontinued.

If I am taking any medication, what should I know?

This report provides a summary of available information about the use of Adderall XR during pregnancy and breastfeeding. Content is from the product label unless otherwise indicated.

You may find Pregistry's expert report about ADHD here,  and reports about the individual medications used to treat mental health conditions here.   Additional information can also be found in the resources below. 

For more information about Adderall XR during and after pregnancy, contact http://www.womenshealth.gov/ (800-994-9662 [TDD: 888-220-5446]) or check the following link:

WebMD: Adderall

Read the whole report
General information

It is very common for women to worry about having a miscarriage or giving birth to a child with a birth defect while they are pregnant. Many decisions that women make about their health during pregnancy are made with these concerns in mind.

For many women these concerns are very real. As many as 1 in 5 pregnancies end in a miscarriage, and 1 in 33 babies are born with a birth defect. These rates are considered the background population risk, which means they do not take into consideration anything about the health of the mom, the medications she is taking, or the family history of the mom or the baby’s dad. A number of different things can increase these risks, including taking certain medications during pregnancy.

It is known that most medications, including over-the-counter medications, taken during pregnancy do get passed on to the baby. Fortunately, most medicines are not harmful to the baby and can be safely taken during pregnancy. But there are some that are known to be harmful to a baby’s normal development and growth, especially when they are taken during certain times of the pregnancy. Because of this, it is important to talk with your doctor or midwife about any medications you are taking, ideally before you even try to get pregnant.

If a doctor other than the one caring for your pregnancy recommends that you start a new medicine while you are pregnant, it is important that you let them know you are pregnant.

If you do need to take a new medication while pregnant, it is important to discuss the possible risks the medicine may pose on your pregnancy with your doctor or midwife. They can help you understand the benefits and the risks of taking the medicine.

Ultimately, the decision to start, stop, or change medications during pregnancy is up to you to make, along with input from your doctor or midwife. If you do take medications during pregnancy, be sure to keep track of all the medications you are taking.