To use or not use some medications during pregnancy – or even when trying to conceive – is a topic I am very passionate about. The one thing that’s important to remember is that the decision to treat with pharmaceuticals is not always black and white. Medications aren’t just “safe” or “not safe,” and especially during such a critical time of a woman’s life. Many factors influence the safety of drugs when a woman becomes of childbearing age, including genetics, hormones, and even brain chemistry.
The Centers for Disease Control (CDC) recently released some research about the drastic increase in the use of ADHD (Attention Deficit Hyperactivity Disorder) medications among US women aged 15-44 – the childbearing ages for most. I was very surprised to see that the exact increase was 344%; with the largest increase occurring for women aged 25-29. These numbers are substantial and present a major health concern, given that roughly half of US pregnancies are unplanned. The effects of ADHD medications during the early stages of fetal development are still largely unknown.
There are several types of medications on the market that can be used for ADHD, but they can roughly be divided into “stimulant” drugs (Adderall, Concerta, Ritalin, etc.,) and “nonstimulant” (Strattera). You may be wondering why a stimulant drug would be helpful to a person who has a hard time paying attention, feels the need to be “on the go”, or otherwise feels disorganized or unfocused. The truth is, the exact reason stimulant drugs work is unclear. They affect brain chemistry – largely the neurotransmitters dopamine and norepinephrine – but even this mechanism doesn’t fully explain how it works.
I usually like to think of stimulant ADHD drugs working in this fashion: while they are “stimulating,” they stimulate the parts of the brain that control behavior and attention. This is potentially why we see benefits in focusing and controlled behavior. Yet, they also have other “stimulating” effects on the rest of the body, such as nervousness, insomnia, palpitations, and increased heart rate – just to name a few. Many parents worry about stimulant ADHD medications causing growth suppression in their children due to loss of appetite and weight loss. Needless to say, there are many factors to consider and monitor upon initiating/maintaining ADHD treatment.
The drastic increase of ADHD medications among women was with stimulant ADHD medications. Interestingly, the use of nonstimulant Straterra (atomoxetine) was relatively stable over time.
Most ADHD medications are rated a Pregnancy Category “C” – which means that well-controlled studies have not been conducted and the use during pregnancy should only be continued if the potential benefits outweigh the potential risks to the fetus. The effects on early fetal development are unknown. Although we are lacking evidence, ADHD medications might be linked to poor pregnancy outcomes, including spontaneous abortion.
Now – this is another subject that is riddled with controversy and mixed evidence – but we have to do our due diligence to see if the increase in ADHD medication use in childbearing females is not-at-all, somewhat, or greatly contributing to higher autism rates in our children. The data from the CDC suggests a large increase in autism diagnoses from 2000 to 2012, which is roughly the time span from the ADHD study. If you’re a mother whose child has been diagnosed with autism or another behavioral disorder, I don’t have to tell you that your mind runs crazy with possibilities and explanations. You may find yourself “googling” just about everything that your sanity can muster. As a mother, I know the pain of seeing a child struggle, and my goal is to not cast fear or guilt on an already sensitive issue. Many times, things simply just happen without reasonable explanation. I stress that many unclear factors go into an autism diagnosis, but the numbers suggest taking an intense further look at the effects of stimulant ADHD medications during early fetal development.
The first trimester in pregnancy is incredibly important for fetal brain development and exponential growth. Nerve cells begin to form and set the “blueprint” for further development and maturation. It is during this time that dangerous chemicals and substances may have the greatest impact. It is also during this time that many women are unaware of their pregnancy. In fact, most women find out they are pregnant during weeks 4 through 7. The cerebral cortex starts to appear in the fetus at roughly 6 weeks. This is the largest part of the brain and is associated with higher brain function, such as thought and action.
We have to assume that any chemical or substance that affects a mother’s nervous system will have the potential to affect the fetus. Again, much of this is unknown, but we must assume so for safety’s sake. I advise most women to stay away from antidepressants, anti-anxiety medications, and other medications that affect the Central Nervous System during pregnancy as much as possible, unless the concerns and risks to the fetus are dire.
I believe the “tried and true” rules for pregnancy need to be revised a bit. As much focus is given to seafood mercury and unpasteurized cheeses, there needs to be a greater emphasis on safe pharmaceutical use and the avoidance of toxic chemicals (and especially during preconception phase). Not to ruffle feathers, but a small glass of quality red wine is probably a lot safer than a preservative-filled fast food meal. Now, we all know the dangers of alcohol on a fetus; however, my point is that we should be shifting our focus slightly for today’s knowledgeable, modern woman who can read the statistics and make her own informed decisions.
Natural Ways to Help ADHD
If you’re an adult suffering from ADHD, it is beneficial to take a look at some natural, non-drug options to help your symptoms:
Omega 3 fatty acids: Omega 3 supplements, such as fish oil, have been shown to benefit some ADHD patients. Omega 3 fatty acids are crucial for brain function and can even help with depression, fatigue, and inflammation. I like consuming a diet high in omega 3 fatty acids (think wild-caught salmon, eggs, spinach, walnuts), or you can also take a reputable fish oil supplement. Vegans can use a flax seed supplement as an alternative.
Vitamin B6: Vitamin B6 is critical for nerve development and transmission. It can also help with brain chemical utilization, such as dopamine, serotonin, and norepinephrine. Tuna, bananas, wild-caught salmon, and grass-fed lamb or beef are all high in vitamin b6.
Probiotics: Research has linked ADHD to digestive issues. Try taking a probiotic that has at least 15 billion CFUS and a diverse amount of strains.
Limit sugar, artificial sweeteners, and caffeine: Sugar can be a trigger for symptoms, especially in children. Artificial sweeteners are not any better and can wreak havoc on overall health and digestion. Caffeine is tricky – some invalidated studies have shown it can be beneficial for ADHD symptoms, but it is largely best to avoid due to the jittery side effects.
Make breakfast your most important meal: Many nutritionists advocate making breakfast the largest, most important meal for weight-conscious individuals. They suggest that maintaining a healthy weight not only has to do with caloric intake, but the timing of food. Have you heard of the expression, “Eat breakfast like a king, lunch like a prince, and dinner like a pauper?” For individuals with ADHD, eating this way can help with stabilizing blood sugar levels. For many of us, the morning and daytime hours should be the most productive and focused part of the day. Eating a big breakfast can help see us through.
Regular sleep and exercise: Both are needed for balancing hormones, reducing stress, and promoting cognitive health. Much of our brain “repairs” during sleep, so it is important to get at least 8 hours.
Support groups: These days, either virtual or physical support groups for just about anything can be found just about anywhere. There’s a certain camaraderie that can be provided, and many feel comforted and reassured knowing they are not alone with their symptoms.
Use organizational techniques: Writing things down, utilizing calendars, and setting alarms and reminders can be extremely helpful in navigating everyday life. Acknowledge your productive behavior with healthy rewards from time to time. Having a reward system in place can help keep you motivated and stay on task – just don’t forget to cash them in!
Back to the statistics regarding ADHD medication – we need to be asking prescribers as well what they feel is the reason for such a drastic increase. Are there justifiable concerns? Is it for patient satisfaction only? Is there something intrinsic or exogenous that is contributing to higher ADHD diagnoses? Whatever the reasons may be, I hope they become clearer over time, and we at least see some stabilization with regards to these potentially dangerous drugs.