The National Comorbidity Survey (NCS) Replication Survey (NCS-R) was an epidemiologic study of numerous psychiatric disorders, including ADHD. The survey contained questions about childhood ADHD and a question about its persistence into adulthood; 70% of subjects who confirmed childhood ADHD responded that they continued to have ADHD in adulthood. The survey also demonstrated that the prevalence of ADHD in adults in the United States is approximately 4.4%1; therefore, it is expected that many adult women will continue to have symptoms during pregnancy.
When considering how to counsel women about ADHD treatment during pregnancy, it is worthwhile to review the risks of untreated ADHD on pregnancy and fetal development. However, no group has specifically researched this topic. Much information is known about the impairment caused by ADHD on the general adult population. In the NCS-R, a diagnosis of ADHD was associated with greater marital problems, unemployment, and difficulties in the workplace, and frequent workplace absence.1 Other studies have also examined the impact of ADHD on functioning in several domains.
Compared with control subjects, those with ADHD had lower educational performance and attainment, with 32% failing to complete high school. More subjects with ADHD had been terminated from more jobs and had lower job performance reviews. Socially, those with ADHD had fewer close friends, more trouble keeping friends, and more social problems, as rated by parents. Far more subjects with ADHD had become parents (38% vs 4%) and had been treated for a sexually transmitted disease (16% vs 4%).3 Adults with ADHD were also more likely to have had multiple marriages and high rates of separation and divorce.4
ADHD has also shown to have deleterious effects on driving; more subjects with ADHD than control subjects had been cited for reckless driving, driving without a license, and hit-and-run accidents. Official driving records indicated more subjects with ADHD had received traffic citations and had a greater frequency of license suspensions.5 Although there are no specific data on the effects of ADHD on pregnancy outcomes, extrapolating data from the general adult population suggests possible significant effects. ADHD is also highly comorbid with other psychiatric disorders that are known to have a significant impact on pregnancy. The NCS-R found that in the respondents with ADHD, 38.3% had a comorbid mood disorder, 47.1% had a comorbid anxiety disorder, and 15.2% had a comorbid substance use disorder (SUD).1 The particular relationship between ADHD and substance abuse has been investigated by several groups. Despite lower rates in the general community, as indicated by the NCS-R, as many as 50% of those with ADHD have a comorbid SUD.6,7
This finding is consistent with the idea that SUD comorbidity is highly impairing and motivates individuals to seek treatment. Those with ADHD have also been found to have an earlier onset of SUD.8 Study groups have found that adults with ADHD and comorbid substance abuse problems took longer to recover and had more severe forms of their substance abuse disorders.9 Given the well-known deleterious impact of mood disorders, anxiety disorders, and SUDs on pregnancy, and their significant comorbidity with ADHD, it is important to take this information into consideration when performing preconception counseling for women with ADHD.