More women of childbearing age are taking medication for attention deficit hyperactivity disorder (ADHD).
And it has raised some concerns among officials at the Centers for Disease Control and Prevention (CDC).
According to the CDC’s recently published findings in its Morbidity and Mortality Weekly Report (MMWR), there was a 344 percent increase in the number of women ages 15 to 44 who filled prescriptions for medications to treat ADHD.
Among age groups, there was a 700 percent increase in women between 25 to 29 years old. There was also a 560 percent increase in women 30 to 34 years old.
CDC officials note there isn’t much research on the effects that ADHD medication has on unborn children.
So, the agency is throwing up a caution flag when it comes to younger women and ADHD medications.
“Half of all pregnancies in the United States are unplanned and women may be taking prescription medicine early in pregnancy before they know they are pregnant,” Coleen Boyle, PhD, MSHyg, director of the CDC’s National Center on Birth Defects and Developmental Disabilities, said in a statement. “Early pregnancy is a critical time for the developing baby. We need to better understand the safest ways to treat ADHD before and during pregnancy.”
“If a woman is pregnant or thinking about becoming pregnant,” added Boyle, “she should talk to her healthcare provider about all medicines she is taking. Pregnant women should also talk to their doctor before stopping or starting any medicine.”
The recommendation is similar to a 2016 advisory in which the CDC encouraged women of childbearing age to abstain from alcohol unless they’re on birth control.
Being realistic about the risk
Nonetheless, for women considering pregnancy (or currently expecting) who rely heavily on their properly-dosed ADHD medication to function daily, the risks seem to be low.
“While the data on ADHD medications is still not conclusive due to the small number of studies,” explained Dr. David Jones, director of the University of Vermont Medical Center Fetal Diagnostic Center. “It appears that overall the risk of birth defects from first trimester use is minimally increased — if it is increased at all.”
“Similarly,” Jones told Healthline, “while there might be a very small increase in the rates of preterm birth, preeclampsia, and abruption in women using these medications, the absolute risk is small and must be balanced against the very real impact that discontinuing a medication would have on a woman’s ability to function.”
Indeed, few medications are deemed completely safe for use during pregnancy. And, with greater advances in technology and medication for a variety of conditions and chronic illnesses, Jones said more women are able to safely pursue pregnancy than ever before.
“As always,” cautioned Jones, “we recommend using medications at the lowest dose possible required to provide the necessary treatment effect, particularly in the first trimester, as that is when most birth defects occur.”
Looking at ADHD medications, diagnosis
Most ADHD medications fall under the category of “methamphetamine” or “methylphenidate.”
“Methamphetamine is related to ephedrine and amphetamine. It also works by stimulating the CNS (central nervous system),” explained an article on Healthline. “It’s not known exactly how this drug works to help ADHD symptoms. It can reduce your appetite and increase your blood pressure.”
“Methylphenidate,” on the other hand, “works by helping the reuptake of norepinephrine and dopamine in your brain. It’s also a mild stimulant.”
Adding to the problem is the fact that many adults don’t seek out an ADHD diagnosis, even though it might be a simple determination to make.
“I find it much easier to diagnose adults with ADHD, as adults have a lifetime of small failures, challenges, and a pervasive pattern of attentional difficulty that when they receive a diagnosis there is a great sense of relief and finally an explanation for why they have struggled for so long,” Barbara Boutsikaris, MS, LCMHC, a marriage and family therapist in Vermont, told Healthline.
While Boutsikaris doesn’t prescribe treatment, she does offer preliminary diagnoses and referrals for her patients.
“Parents,” she said, “are much more resistant to the diagnosis in their child because they often believe that it is over-diagnosed and are understandably afraid of medicating their child. However, since it is a genetic condition, once I’m able to identify the same symptoms in one of the parents, they usually get on board with their child’s diagnosis.”
Additionally, Boutsikaris herself was diagnosed with ADHD at 40 years of age.
Her own diagnosis came when she was perimenopausal and was actually first identified by her own daughter.
“My daughter unofficially diagnosed me when she said, ‘Mommy, I need to take your batteries out.’”
To help her patients with a preliminary diagnosis, she uses the Self-Report Adult ADHD Scale. High scores on the test lead to a simple referral elsewhere for an official diagnosis.
“I often see adolescents and adults who are highly intelligent but are not successful in their life,” explained Boutsikaris, “or struggling with anxiety and/or depression which is secondary to their undiagnosed ADHD. These are often the adults who as children and teenagers just barely got by or struggled in school. They were called ‘lazy’ or ‘not living up to potential.’”
Boutsikaris suspects that one cause for the increase in ADHD medication use is linked to the fact that a study at the University of Vermont found that the most effective treatment is actually nicotine.
“My theory is that with the decrease in people self-medicating with cigarettes, there has been an increase in ADHD in adults,” she said.