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Attention deficit hyperactivity disorder (ADHD)

Autistic spectrum disorder (ASD)

Attention deficit hyperactivity disorder (ADHD) before, during and after pregnancy

If you have ADHD it’s important to tell your doctor before you get pregnant or as soon as possible during pregnancy. Your doctor and midwife will make sure you get the treatment and support you need.

What is ADHD?

Attention deficit hyperactivity disorder (ADHD) affects behaviour and can be diagnosed in childhood or adulthood. Up to 1 in every 20 adults (men and women) has ADHD.

Symptoms can improve as you get older but adults may:

  • find it hard to concentrate
  • be forgetful
  • put off finishing tasks 
  • feel restless
  • interrupt other people
  • have mood swings
  • find it hard to deal with stress
  • take risks without thinking about their or other people’s safety, for example by driving dangerously.

Your symptoms may not change during pregnancy. You may also have other health problems such as anxiety, depression or an autism spectrum condition.

Planning a pregnancy with ADHD

It’s important to use a reliable form of contraception until you have spoken to your doctor.

Planning your pregnancy will give you time to make sure you’re on the right type and dose of mental health medication. This will help to reduce any risk to you and your baby.

If you take medication for your ADHD, your doctor may advise you to stop taking it or change to another type. This is because we don’t fully understand how ADHD medication could affect a developing baby.

Do not stop taking your ADHD medication before talking to your doctor. This can make your symptoms come back or get worse.

If you need to continue taking ADHD medication during pregnancy, your doctor may recommend methylphenidate or amphetamines. There has been more research into the effect of these medicines during pregnancy so doctors know more about their safety than other medicines.

If you are already pregnant, tell your midwife or healthcare team straight away and before you stop taking your medication.

During pregnancy

If you let your midwife and health visitor know you have ADHD they can give you extra support. For example, they can give you written information to help you remember what has been said during your antenatal (pregnancy care) appointments. They may also send you text messages to remind you of your next appointment.

You may find it helpful to write a list of questions and take this to your appointments.

If you take ADHD medication in the last few weeks of pregnancy, your baby will be closely monitored for a few days after the birth. This is because there’s a risk your baby could be dependent on the medication, so their body needs time to get used to not getting it.

Preparing for the birth

You may find it helpful to prepare for the birth a few weeks before your baby is due. For example, you could write a list of things you need to get for your baby, pack an overnight bag for the hospital and save the phone numbers for the labour ward and midwives in your mobile phone. You might also like to do a birth plan with your midwife.

After your baby is born

The midwifery team will monitor your baby after the birth and give them any extra care they may need. You will usually be able to stay with your baby on the postnatal ward but your baby may be looked after in a specialist newborn (neonatal) unit if they need further monitoring or treatment.

Your GP or health visitor will continue to support you after your baby is born and can help you with any worries or questions you may have. If you’re a first time young mum, you may also see a family nurse who can offer support.

Read more about thinking ahead to after the birth here

Breastfeeding

Your doctor will explain the risks and benefits of taking ADHD medication if you choose to breastfeed. You can ask them to write this information down so you can read it at home.

Many ADHD medicines pass into breastmilk but it isn’t always clear whether they affect the baby.

You may need to change the dose or type of your medication or you may take it once a day straight after you’ve fed your baby.

Some medicines, such as modafinil or bupropion, are known to cause health problems in babies. If you’re taking these, your doctor will advise changing the medicine.

Your health visitor or doctor will check your baby to make sure the medication isn’t causing them any health problems.

If you choose not to breastfeed, your midwife and health visitor will support you with formula feeding. Or you may decide to mix breast and bottle feeding. Your healthcare team will support you whatever you decide is best for you and your baby.

More information and support

Adders

Royal College of Psychiatrists

Autistic spectrum disorder (ASD or autism) before, during and after pregnancy

If you have autism it’s important to tell your GP and midwife so they can support you before, during and after pregnancy.

What is autism?

Autism is a condition that you’re born with. It’s a spectrum, so it is different for everyone but if you have autism you may:

  • find it hard to communicate and interact with other people or understand how they think or feel
  • be over-sensitive or under-sensitive to your environment, for example to sounds, smells, touch, light or temperature
  • worry about unfamiliar and unexpected situations and social events
  • find routine and rules reassuring.

You may also have other health problems, such as epilepsy, anxiety, depression or attention deficit hyperactivity disorder (ADHD) or difficulties with eating or sleeping.

Some people with autism need daily help from a family member or carer whereas others need little or no support.

Planning a pregnancy with autism

If you take any medication, for example for other mental or physical illnesses, it’s important to use a reliable form of contraception until you have spoken to your doctor. They can tell you whether your medication is safe to take in pregnancy. They may advise you to stop taking your medication or change to another type of medicine to help prevent any possible harm to your baby.

Do not stop taking any medication before talking to your doctor. This can make your symptoms come back or get worse.

Many pregnancies are not planned. If you are already pregnant, tell your midwife or healthcare team straight away. Don’t stop taking any prescription medication without talking to them.

During pregnancy

You will have routine antenatal (before birth) appointments with your midwifery team. If you are worried about these, you may find it helps to tell the midwife about your autism and how it affects you. This can help them make it easier for you to get the most from your appointments. For example, you could ask if you can have appointments on a certain day or at the same time of day. You can ask them to explain in advance what will happen at your appointments and for written information to take home after each appointment.

You can also make a hospital passport to help you tell health professionals what your needs are.

At your first appointment, ask if you can have one named midwife for your care – this is called 'contunuity of care' and many areas are working towards this.

Remember that your midwife and doctor want to help you and your baby and will not judge you.

There isn’t much evidence to show how autism may affect pregnancy and birth but there is some suggestion that pregnant women on the autistic spectrum have a higher than average risk of:

Having your baby

Some autistic women say they would have liked to feel more in control during labour. Some have found it helpful to write a birth plan. If you have strong sensory likes or dislikes, or unusual pain response, it may be useful to note these in your birth plan.

You may find it helpful to go on a tour of the maternity unit so you’re more familiar with the environment before you go into labour.

Some women worry about whether they will bond with their baby, whether or not they’re autistic. You may bond with your baby straight away or it may take more time. There are some things you can do to help you build a strong relationship with your baby.

[Potential video for inclusion https://vimeo.com/144762664]

Feeding your baby

Whether you choose to bottle feed or breastfeed your baby, there is support available to help you. Your midwife will help you start to feed your baby after the birth. Your health visitor is a good source of support and can tell you about breastfeeding support services in your area.

If you take medication for other health problems, ask your doctor if they are safe to take while you’re breastfeeding. Some medicines can pass into breastmilk but you may be able to change the type or dose. Don’t stop taking any medication suddenly without speaking to your doctor as this may make your symptoms worse.

Will my baby be autistic?

Autism sometimes runs in families but this doesn’t always mean that your baby will be autistic. Unless your autism is linked to a genetic condition, such as Fragile X syndrome, there’s no way of knowing how likely it is that your baby will be autistic.

We don’t know what causes autism but it’s likely that different causes affect different families. There may be several causes, including genetic and environmental factors. In some families, children may inherit the increased chance of developing autism, rather than inheriting autism itself. You can ask to speak to a genetic counsellor if you are concerned or would like more information.

If your child is autistic, you may notice their symptoms in early childhood or not until they’re older.

If you’re worried that your baby or child may be autistic, you can speak to your GP, health visitor or any other health professional that your child sees.

Where can I get support?

A new baby changes your routine a lot, and that can be hard to deal with. Your health visitor will visit you at home after your baby is born to offer you support. Some women find it hard to put into practice the information they read in books and leaflets, whether or not they’re autistic. You could ask your health visitor to show you what to do instead of giving you printed information.

For example, they could show you how to bath your baby, if you haven’t been shown in hospital, or how to soothe your crying baby. Family members and friends can also help with this. It’s always good to ask for advice and tell someone if you feel you would like help.

Your GP and health visitor will continue to support you after your baby is born and can help you with any worries or questions you may have. If you’re a first time young mum, you may also see a family nurse who can offer support.

More information and support

NHS autism guide

National Autistic Society

Ambitious about Autism

Mums on the spectrum facebook group

More information on this topic

More support for you

Thinking ahead

Sources

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  • NHS. (2018) Attention deficit hyperactivity disorder (ADHD): symptoms www.nhs.uk/conditions/attention-deficit-hyperactivity-disorder-adhd/symptoms/
  • Bolea-Alamanac B et al. (2014) Evidence-based guidelines for the pharmacological management of attention deficit hyperactivity disorder: Update on recommendations from the British Association for Psychopharmacology. Journal of Psychopharmacology 1–25.
  • Ornoy A (2018) Pharmacological Treatment of Attention Deficit Hyperactivity Disorder During Pregnancy and Lactation. Pharmaceutical Research 35(3): 46.
  • Bolea-Alamanac B et al. (2014) Evidence-based guidelines for the pharmacological management of attention deficit hyperactivity disorder: Update on recommendations from the British Association for Psychopharmacology. Journal of Psychopharmacology 1–25.
  • UK Teratology Information Service (2018) Use of methylphenidate in pregnancy https://www.medicinesinpregnancy.org/bumps/monographs/USE-OF-METHYLPHENIDATE-IN-PREGNANCY/
  • Ornoy A (2018) Pharmacological Treatment of Attention Deficit Hyperactivity Disorder During Pregnancy and Lactation. Pharmaceutical Research 35(3): 46.
  • NHS (2019) What is autism? www.nhs.uk/conditions/autism/what-is-autism/
  • National Autistic Society (2016) What is autism? www.autism.org.uk/about/what-is/asd.aspx
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  • NHS (2019) What is autism? www.nhs.uk/conditions/autism/what-is-autism/
  • Rogers C et al. (2017) Perinatal issues for women with high functioning autism spectrum disorder. Women Birth 30(2): e89–e95.
  • Sundelin HE et al. (2018) Pregnancy outcomes in women with autism: a nationwide population-based cohort study. Clinical Epidemiology 10: 1817-1826
  • Gardner M et al. (2016) Exploratory study of childbearing experiences of women with Asperger Syndrome. Nurs Womens Health 20(1): 28–37
  • Lai MC, Lombardo MV, Baron-Cohen S (2014) Autism. Lancet 383(9920): 896–910.
  • Great Ormond Street Hospital for Children (2015) Genetics of Autistic Spectrum Disorders: information for families. www.gosh.nhs.uk/file/11716/download?token=4HHz6kc-
  • US National Library of Medicine (2020) Genetics Home Reference: Autism spectrum disorder. https://ghr.nlm.nih.gov/condition/autism-spectrum-disorder#inheritance
  • Parr J, Woodbury-Smith M. (2018) BMJ Best practice: Autism spectrum disorder.
  • Gardner M et al. (2016) Exploratory study of childbearing experiences of women with Asperger Syndrome. Nurs Womens Health 20(1): 28–37.
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