Women with attention-deficit/hyperactivity disorder (ADHD) often discontinue ADHD medications while pregnant, especially in the event that they have milder symptoms. While this approach is smart by way of limiting unnecessary exposures in women with milder illness, we now have often been surprised by clinical outcomes on this population, specifically when women who were previously high functioning experience significant psychiatric morbidity while pregnant and the postpartum period after discontinuation of ADHD medications.  

A recent study from Sweden examines the danger of postpartum depression and anxiety in women diagnosed with ADHD. On this study, researchers used register-based data to discover women who gave birth to their first and/or second child between 2005 and 2013 in Sweden (n = 773,047). On this cohort, 0.5% (n = 3515) of the ladies carried a diagnosis of ADHD prior to pregnancy. Diagnoses of depression and anxiety disorders up to at least one yr after delivery were collected from the national register.

Among the many women with ADHD, 16.8% of the ladies were also diagnosed with depression in the course of the postpartum period. The prevalence of depression in women with ADHD was about fivefold higher than observed in women with no ADHD diagnosis (prevalence ratio 5.09; 95% confidence interval, 4.68-5.54). 

A complete of 24.92% of the ladies with an ADHD diagnosis were also diagnosed with anxiety disorders within the postpartum period. The prevalence of tension in women with ADHD was about fivefold higher than observed in women with no ADHD diagnosis (prevalence ratio 5.41; CI 5.06-5.78). 

Although a complete of 59% of the ladies diagnosed with ADHD carried additional psychiatric diagnoses (in comparison with only 5% of the ladies without ADHD), they observed  that ADHD was an independent risk factor for postpartum depression and anxiety.  

Clinical Implications

The findings of this study indicate that ADHD is a vital risk factor for postpartum depression and postpartum anxiety disorders. While we routinely ask our patients a few history of mood and anxiety disorders when estimating risk for perinatal mood and anxiety disorders, we less often ask about ADHD, especially in women with milder illness or in those that are currently not using ADHD medications. Given the relatively low prevalence of ADHD documented within the medical record on this study, it is probably going that the ladies at biggest risk are those with more severe ADHD symptoms or those requiring pharmacotherapy. From this study, we cannot determine whether women with milder symptoms are also at increased risk for mood and anxiety disorders.

Although women with ADHD were more prone to carry other risk aspects for postpartum depression and anxiety, reminiscent of lower education level and lower socioeconomic status, ADHD was an independent risk factor for postpartum depression and anxiety.  

The findings of this study are consistent with a research study from our program (Baker et al., 2022) that observed that ladies who stopped ADHD medications while pregnant were more prone to experience higher levels of depressive symptoms. Although ADHD symptoms remained relatively stable across pregnancy for girls who discontinued psychostimulants, this group of girls experienced a clinically significant increase in depressive symptoms) despite making no changes of their antidepressant medications. In contrast, women who either maintained or adjusted ADHD medications while pregnant experienced no significant change in depressive symptoms.

As well as, women who discontinued psychostimulant treatment while pregnant experienced significant impairment in family functioning. Specifically, they were more prone to experience conflict inside the family, had greater difficulty in having fun as a family, rated parenting as harder, and described being more isolated from their family.

Ruta Nonacs, MD PhD

References

Baker AS, Wales R, Noe O, Gaccione P, Freeman MP, Cohen LS. The Course of ADHD during Pregnancy. J Atten Disord. 2022 Jan;26(2):143-148. 

Andersson A, Garcia-Argibay M, Viktorin A, Ghirardi L, Butwicka A, Skoglund C, Madsen KB, D’onofrio BM, Lichtenstein P, Tuvblad C, Larsson H.  Depression and anxiety disorders in the course of the postpartum period in women diagnosed with attention deficit hyperactivity disorder.  J Affect Disord. 2023 Jan 18: S0165-0327(23)00085-X.