In the case of Mrs. L., she presented before conception and there was time to weigh all treatment possibilities and assess the impact of a stimulant taper on her functioning prior to pregnancy. This case is the ideal scenario, as there is an opportunity to carefully weigh the benefits and risks of taking a medication for which there are very limited data in pregnant women. However, another common scenario is a woman who presents with an unplanned pregnancy while on stimulants and seeks counseling on whether to continue treatment. This situation proves more challenging, as there is not time to assess the woman’s functioning off treatment, and the clinician must rely on history alone.
Although Mrs. L. stated that her decision to not conceive was unrelated to the recommendation to attempt to taper off stimulants, the question remains whether this factor played a role in her decision-making process. When providing preconception counseling, clinicians should remain sensitive to the importance stimulants can have on the lives of their patients. Additional data on the impact of ADHD on pregnancy outcomes are necessary, as well as further data on the risks of treatments of ADHD on the developing fetus, such that patients can make informed decisions about treatment and pregnancy.
Katherine Martin, MD, is a consult-liaison psychiatrist with the Lehigh Valley Health Network in Allentown, Penn. She is also an assistant clinical professor of psychiatry at University of South Florida Morsani College of Medicine in Tampa. She completed an elective in reproductive psychiatry during her residency.
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