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ADHD is a condition mostly diagnosed in childhood, but it lasts into adulthood. One has to learn to live with the attention deficit, hyperactivity, and it can add to the already difficult adventure of being pregnant.
Having ADHD during pregnancy is totally survive-able! However, there will be additional challenges depending on whether you decide to medicate and other factors.
This article explores what to expect with ADHD when you are pregnant, the types of ADHD, and how to manage it during pregnancy.
Important Considerations With Regard to ADHD When Pregnant
The Decision to Stay on or off the Medication
The first thing you can expect is having to make the crucial decision whether to stay on your ADHD medication or stop using it for the duration. Several factors inform this decision.
Your Level of Aggression
It is not uncommon for someone with ADHD to have a hard time managing their feelings and emotions, especially anger and frustration. As a result, you may experience hypersensitivity to criticism and bouts of explosive anger. You are also likely to get flustered or stressed out by things that others would consider minor issues.
These extreme reactions during your pregnancy can be detrimental to your health and that of your baby. For example, stress during pregnancy increases the possibility of having a premature baby born before 37 weeks. It also contributes to low birth weight in babies. Babies born too small or too early are more susceptible to health problems.
Other forms of aggression, like explosive anger, can cause the mother to inflict harm to herself or the baby. And the aggression doesn’t need to be outward. It can be passive aggression towards yourself or your baby as you battle low self-esteem or insecurity.
Poor Memory Function
Studies have shown that pregnant women not suffering from ADHD are significantly impaired on memory measures. This is typically known as pregnancy brain. However, “pregnancy brain” can be more pronounced in pregnant women with ADHD because it exacerbates an already forgetful mind.
One of the classic symptoms of ADHD in adults is chronic forgetfulness. Living with untreated ADHD can be chaotic, as staying on top of things is challenging. As a result, one is bound to forget important doctor’s appointments, lose track of their responsibilities like bill and debt payments, and have trouble finishing projects, among other things.
Occupational Capability and Function
Living with ADHD has not stopped people from having successful careers as long as it is managed by medication. Being off the medicine may reduce your ability to make sound occupational decisions while also affecting your conduct in the work environment.
For example, if your ADHD is characterized by impulsive behavior, without medication, you may respond or act impulsively. In meetings, you could interrupt the speaker, blurt out a comment, or have difficulty staying patient, disrupting your co-workers. If you are in a position of authority, it could affect the image of the company.
Unfortunately, the consequence of this behavior could be losing your relationship with colleagues or, even worse, losing the job entirely.
On the other hand, you could be hyperactive and restless. In such instances, you are constantly on the go and are willing to take risks that could be damaging to your career. You have racing thoughts that you tend to act upon without due consideration.
If you are going to get off your ADHD medication during pregnancy, it is best to alert the workplace of your decision. You may ask for a reduction in your workload, consideration for working from home, and help with organizing your work schedule.
Telltale signs that you need the interventions mentioned above include having many simultaneous thoughts making it difficult to follow one train of thought. Also, if you are constantly zoning out in the middle of a conversation or are struggling to follow instructions, it is time to get some help.
Impaired Day to Day Functionality
ADHD can impair your ability to perform normal day to day functions. Some patients are at a higher risk of motor vehicle accidents as their concentration is reduced. Stimulants used in treating ADHD have been documented as beneficial in improving driving impairments experienced by patients.
The Risk to the Baby
Having decided whether or not to take the medication, the next consideration is the impact of your choice on the baby. According to the CDC, continual use of ADHD medication, especially early on in the pregnancy is associated with at least three congenital disabilities:
- Transverse limb deficiency
Gastroschisis is a congenital disability that affects the abdominal wall of the baby. It is characterized by the exiting of the baby’s intestines through a hole next to the belly button. The intestines lie outside the body, and in some cases, other internal organs like the liver and stomach may also be on the body surface.
This condition develops in early pregnancy when the abdominal muscles are forming. The intestines are exposed to the amniotic fluid, which irritates them and causes them to twist, swell, or shorten.
After the baby is born, the intestines can be put back into the body. However, the infant may have issues with nursing, eating solid foods, and digestion.
Like gastroschisis, this condition is also characterized by internal organs like the liver, intestine, and stomach, which are stuck outside the belly. However, in this case, the organs come out
through the belly button and are contained in a transparent sac.
During normal fetal growth, the intestines of a baby grow longer between the sixth and the tenth weeks and push outwards through the umbilical cord. By the eleventh week, they normally retract into the belly. Omphalocele occurs when the retraction doesn’t happen, and the intestines remain outside.
Babies with this condition may have smaller abdominal cavities and also run a high risk of infection if the sac breaks.
Transverse Limb Deficiency
This condition occurs when the limb of a fetus doesn’t fully develop, or it is missing completely. Transverse limb deficiency causes the baby to grow with movement limitations as well as difficulty with motor skills.
The limb deficiency can accompany any of the two conditions named above. Once the baby is born and has grown a bit, some doctors recommend using prosthetics for the missing limbs.
The Risks to Your Health
If you have decided to stop taking ADHD medication during your pregnancy, you can expect to encounter withdrawal symptoms including:
- Trouble sleeping
- Excessive fatigue
- Stomach cramping
- Nausea and vomiting
The withdrawal symptoms may last from two days to weeks. The major health concern is that as you try to overcome these symptoms, the typical symptoms of ADHD begin to set in. Handling both may be overwhelming while pregnant. The result may be poor mental health with deep depression and suicidal thoughts becoming a primary concern.
Doctors recommend gradual withdrawal from the drugs rather than trying to quit cold turkey. Most pregnant women with ADHD can manage withdrawal symptoms when they adopt this approach. However, keep your doctor informed of the progress and any warning indicators of unhealthy behaviors.
Most importantly, before stopping your medication, get a thorough examination from a doctor to give you the green light. Some ADHD medications are taken only under a doctor’s supervision and for a short time. The severity of withdrawal symptoms is dependent on the medication and the length of time you have been taking it.
ADHD in Fetal Development
ADHD runs in the family, meaning a child with the condition most likely has a parent who passed it down to them. Research is ongoing to ascertain the main cause of the condition, but genetics and problems with the central nervous system, among other things during fetal development have been identified as key factors.
A team of researchers from John Hopkins University has found that cloud screening of lipid profiles during pregnancy may help prevent and manage ADHD. According to their findings, low levels of maternal high-density lipoprotein (HDL) can increase the risk of ADHD. They also found that this association was more pronounced in boys putting the male babies at higher risk for ADHD compared to female babies.
HDL is good for pregnant women because it destroys LDL (Low-density lipoproteins), which increases the chances of disease like hypertension and heart disease.
Another study from Uppsala University in Sweden showed a correlation between maternal weight and ADHD risk. Prenatal obesity and overweightness were significantly associated with
Doctors recommend a healthy diet and exercise in women before, during, and after pregnancy to keep ADHD at bay from mother and child. Doing this will help increase your HDL (high-density lipoproteins).
A difficult pregnancy can also lead to ADHD, especially if it has complications that affect the baby’s brain. The complications can occur during fetal development or the delivery of the baby.
Some of the issues that may result in ADHD include:
- Bleeding before the baby is born
- A very lengthy labor process
- Babies who are way past their due date
- High blood pressure during pregnancy
- Situations that impact the oxygen supply to the baby
Types of ADHD
There are three main types of ADHD:
- ADHD combined type
- Predominantly ADHD hyperactive/impulsive type
- Predominantly ADHD distractible and inattentive type
ADHD Combined Type
ADHD is diagnosed by carrying out a detailed evaluation of the individual using intellectual screening, attention and distraction tests, memory tests, and looking at the family medical history. If at the end of the evaluation, the patient exhibits hyperactive, inattentive, and impulsive behaviors, then they are diagnosed with ADHD combined type. This type of ADHD is the most common in both adults and children.
All the above types of ADHD have one definition in common: They are a result of lower dopamine levels, which causes low brain metabolism in the areas concerned with attention, movement, and social interaction.
The doctors use the criteria outlined in the DSM-5. To be diagnosed with ADHD combined type, the physician has to identify 18 symptoms of ADHD: nine symptoms of hyperactivity-impulsivity and nine symptoms of inattention according to the DSM-5. The symptoms must have been present for six months or more.
Also, the symptoms must not be explicable based on anxiety or mood disorders.
Predominantly ADHD Inattentive/Distractible Type
This type of ADHD is diagnosed after one’s performance in the attention and distraction tests, as well as the memory tests. The typical symptoms of this ADHD include:
- Difficulty focusing on details
- Quick and easy distraction
- Forgetfulness even after a recent conversation
- Very poor organizational skills for one’s age
- Poor study and work skills for one’s age
- A very short attention span for one’s age group
- Difficulty listening to other people
Predominantly ADHD Hyperactive/Impulsive Type
People with this type of ADHD find patiently sitting still very challenging. Even when they sit, they may squirm, clasp and unclasp their hand, drum fingers or tap their feet. They are often unable to sit down for long periods of time, making it hard to fit in structured environments like classrooms or offices.
It is possible for adults suffering from this type of ADHD to be physically seated but have internal restlessness. Some of the words used to describe these patients include too unruly, too energetic, always on the move, or even chatterbox because they can’t sit silently.
In both adults and children with this type of ADHD, waiting a turn is a major challenge that lands them in trouble with other people often. They may even intrude on other people’s conversations or activities.
Importance of Diagnosing the Right ADHD
It is crucial to have the right diagnosis when it comes to ADHD because this ensures you get the right treatment. The more information you learn about your ADHD, the better you are able to manage it. Some people have unique personalities that have nothing to do with the condition. On the flip side, others blame their personalities on what is actually a symptom of ADHD.
Misdiagnosis of the type of ADHD can have profound psychological, social, and financial consequences on the individual, their family, and their community at large. Treatment may not normalize the person, but it can allow them to live a dignified life and even become a productive member of society.
Not treating ADHD can result in a buildup of other disorders including:
- Anxiety disorder
- Personality disorders
- Antisocial behavior
How to Manage ADHD During Pregnancy
Typically the physicians will recommend the use of amphetamines and other psychostimulants to treat ADHD. Most of the doctors caring for pregnant women with ADHD continue to prescribe the psychostimulants because there is no definitive study correlating the drugs to dangers like miscarriage, placenta disruption, or pre-eclampsia.
However, they do monitor their patients very closely and also take extra precautions monitoring the fetus to ensure optimum health for both mother and baby.
Factors that increase ADHD in pregnant women
Negative Life Events
These are life-changing events like death in the family, divorce, or a diagnosis like diabetes or hypertension during pregnancy. It can be hard to deal with these hard changes, and as a result, one becomes hyperactive or impulsive as a coping mechanism.
Being in a constantly stressful situation contributes to increased ADHD episodes. The stress can be caused by being in an abusive relationship, losing a home or job, or any other destabilizing factor.
Natural and human-made catastrophes can trigger fear and anxiety that cause one to behave impulsively. These events include terrorist attacks, earthquakes, and hurricanes, which may be close to home to even far away but affecting the person’s loved one.
Fear of the Unknown
The anxiety that comes with the fear of the unknown can be too much for a pregnant woman with ADHD. For example, the anxiety of bringing up a child in a poor and crime-ridden neighborhood can become overwhelming despite the mother having lived in the same neighborhood before with no fear.
The same applies to women who work in jobs that have no stability, benefits, or health insurance. Or they may be working in environments where they feel unsafe.
ADHD during pregnancy is challenging, but it is not insurmountable. It is possible to have a healthy and happy pregnancy despite having the condition. The secret lies in management and recognition of your ability to overcome the challenges. As long as pregnant women with ADHD:
- Make informed decisions with the help of their physicians
- Eat healthily concentrating on fresh produce, lean meats, fruits, and proper hydration
- Exercise and avoid stressful situations
- Ask for help when they need to scale back their responsibilities
- Prepare adequately before going off their medication or
- Continue to take medicine under close supervision
They will be able to add to their family in a healthy way while managing their condition. As soon as the baby comes, it is time to have another conversation with your physician about breastfeeding and ADHD. That is a crucial aspect of parenting to think about in advance.