ADHD and pregnancy

Pregnancy is an intense time for everyone, but pregnant people with ADHD often face added challenges. ADHD can make pregnancy more complicated because it adds loads of new responsibilities — new things to remember and new distractions. It also may mean changes to your medication and how you manage your symptoms. 

For some pregnant people with ADHD, the first trimester can be especially challenging. Growing a baby can leave you exhausted. Rapidly changing hormone levels can create increased mood swings. You may feel less focused and more forgetful. And if you lower or stop your ADHD medication, you’ll also have to adjust to those changes. 

The good news is that, for most women, ADHD symptoms dramatically drop in the second and third trimesters due to stable high levels of estrogen. 

ADHD can make an already intense time feel more challenging. “How do I implement new habits when I’m not a good implementer of habits in the first place?” asks ADHD coach Patricia Sung. “And now there’s this added level of stress — knowing that you’re going to be a parent, and your actions don’t affect just you,” she adds.

Pregnancy is extra challenging for people with ADHD because it places more demand on the skills that are already difficult. “Being pregnant is like getting a degree in advanced executive functioning,” says Jodi Gold, PhD, an adolescent and adult psychiatrist who works with women with ADHD.

Executive functions are the invisible, but important, set of skills that help people manage daily life. It’s skills like remembering appointments, planning meals, and following instructions. Being pregnant, Gold explains, can make those tasks even harder. “All of a sudden you have more appointments, new distractions, new ways of eating and sleeping. There’s a lot more to remember, you don’t feel as good, your body is different — it’s a big shift.” 

What’s more, you don’t get a break from your other responsibilities. That creates extra stress and can lead to burnout.

Here are some specific difficulties you might face. 

• Managing new tasks: Having trouble with memory and organization makes it tricky to keep track of things like doctor visits, screenings, and prenatal vitamins.¹ You might easily forget if they’re not on a calendar or you didn’t set an alarm. There are also big changes to your basic routines. “For pregnant people with ADHD, just organizing meals can be difficult,” explains Dr. Gold. “Do eat this, don’t eat that, this makes you nauseous….” 

• Planning for the future: On top of your regular life, you probably have lots of new tasks. Signing medical forms. Choosing baby gear. Setting up maternity leave. All of this adds to your mental load — the stress on your brain. You may feel overwhelmed and less able to prioritize or even get started on tasks. “People with ADHD are really in the moment — their strength is not thinking about what’s down the road,” Gold says. “Pregnancy is all about thinking about what’s down the road.”

• Staying focused: The forgetfulness and brain fog that come with pregnancy can make you even more distracted. You might dive so deep into researching strollers that you miss meetings or deadlines. Or maybe you get sidetracked during doctor visits and forget to ask pressing questions. Daily tasks like assignments at work or household chores can also feel harder to do.

• Managing emotions: Having more on your plate during pregnancy ramps up the stress and anxiety you might already feel as you navigate life with ADHD. You might be more easily irritated, frustrated, or emotional. Pregnancy hormones themselves also cause mood swings. A 2022 study showed that ADHD symptoms in pregnancy were associated with higher levels of stress and depression.²

• Managing relationships: Another 2022 study found that during pregnancy, people with ADHD are less likely to get support from family, friends, and significant others. That’s likely because the added stress and mood swings of pregnancy with ADHD can put a strain on relationships.¹ Even if family and friends are supportive and helpful, the distractions that come with pregnancy and ADHD can make it tough to keep up with family or social obligations. Brain fog can also make it even more difficult to remember to respond to texts or emails, or to remember important dates (like birthdays). This can all create challenges in relationships.

Especially during your first trimester, the hormones estrogen and progesterone levels rise dramatically. Research suggests that higher estrogen levels can improve attention and executive thinking skills.³

Progesterone, on the other hand, may be to blame for what some call “pregnancy brain.” Along with a spike in the stress hormone cortisol, it can make you feel tired and foggy, agitated, and distracted.

“The impact of hormones in ADHD fluctuates,” Gold says. “Some people do find pregnancy hormones help them feel more focused and calm. But the majority find that they cause brain fog and fatigue and exacerbate the symptoms of ADHD.”

Not every pregnancy will be affected by hormones in the same way. But generally, people with ADHD can be more sensitive to hormonal changes. 

Should you continue taking your ADHD meds while pregnant? This question causes a lot of anxiety for people with ADHD.

There are two types of ADHD medications: Stimulants, such as Ritalin and Adderall, and non-stimulants, which work by boosting the amount of the brain chemical norepinephrine. Non-stimulant medications can also include antidepressants and anti-anxiety drugs.

A 2024 study shows that stimulants are generally safe to take while pregnant.⁴ Earlier findings suggested that they might slightly raise the risk for premature birth and low birth weight.⁵ “Generally, it’s a very, very small increased risk of complications,” Gold says. “I think it’s a difference of 1.5 to 2 percent.”  

Likewise, a new, small study suggests that stimulants are safe during breastfeeding.⁶ “The amount of meds in your system could be compared to a glass of wine,” Sung says. “It’s so tiny, it’s really not going to make that big a difference.” 

Nonstimulant medications in pregnancy have not been well studied. But a 2022 study suggests that the antidepressant known as Wellbutrin is safe to take during pregnancy.⁵

All this said, no one solution is right for every person or every pregnancy. What works for — and is safe for — one person may not be for another. If you have questions about taking ADHD medications during pregnancy or breastfeeding, discuss it with your health care provider.

In many cases, it’s possible to stay on your ADHD medication during pregnancy and breastfeeding. Some doctors, including Gold, still recommend going off stimulant medication or taking a lower dose during pregnancy to err on the side of caution. That’s especially true if your ADHD symptoms are mild. 

“It’s clear in the research that whatever the risk, as small as it is, it’s dose-dependent,” Gold says. “The risk goes up as the dose goes up. So, it makes sense to decrease the dose.” 

Medication isn't the only way to manage ADHD symptoms during pregnancy. Research shows counseling and coaching, planning, management, and support can also help manage ADHD symptoms during pregnancy.⁷

Gold believes this support is essential whether you decide to stay on medication or not. “I think about it as creating a village,” she says. It might be friends, family, or a partner reminding you about doctor appointments or taking on household chores. It might be recognizing that you may need to work less or shift your hours.”

If you’re lowering your meds or going off them, you’ll also need to manage your expectations. “Your ability to be on top of everything is going to be lower,” says Gold. “I’m not suggesting that it’s easy, but it’s manageable for many people as long as they’ve built a support network.” 

A 2022 study found that people who stopped taking their ADHD medications during pregnancy had more problems with mood and with their relationships compared with people who continued with their medications or lowered their dosage.²

“There are some people with severe ADHD who may need to stay on meds,” Gold says. Without them, they might not keep up with their prenatal visits or take good care of themselves. They could get disorganized and distressed. “We know from studies of anxiety and depression that it’s not great for the fetus to be exposed to increased stress hormones.” 

As with any choice around medication, talking to your health care provider is key. Together, you’ll choose what’s best for you and your future child. 

After delivery, estrogen and progesterone levels plummet, setting the stage for mood disorders. A 2023 study found that new mothers with ADHD are more likely to have postpartum depression and/or postpartum anxiety than new mothers without ADHD.⁸

If you’re worried about your postpartum mental health, talk to your health care provider. If you know you’re at risk for depression or anxiety, you can ask about starting antidepressant medications as early as the seventh month of pregnancy.

Also consider asking a loved one to keep an eye on your mood after you give birth, and watch for signs of postpartum depression or anxiety. “A lot of times when you’re going through it, you don’t realize how much things have shifted,” says Sung, who has ADHD. Two weeks postpartum, her husband flagged her depression and encouraged her to seek help.

“There’s all this shame and guilt,” she says. Sung remembers seeing Instagram reels of people in love with their babies — when she mostly just felt sad for her old life. “The hidden parts of it are where people really struggle because they don’t feel like they can say ‘This is hard and I need help,’” she says.

ADHD can make adjusting to new family dynamics with your baby more difficult. “You’re now taking care of yourself and someone else,” Gold says. There are tons of new things to remember, routines to create, things to buy, and places to be. And maybe you’re not sleeping. All of this can make your ADHD symptoms feel like they’re in overdrive.

An unexpected but common challenge for people with ADHD is trying to be “present” with the baby. Babies, though cute, aren’t always that engaging to be with. That can be tough for ADHD brains. “It’s more challenging when you have ADHD to sit with a baby that doesn’t do anything, and to try to talk to them and be interactive with them,” Gold says. 

Staying active can help. This might look like putting the baby in a carrier or wrap while you clean, or taking walks when you can. Even holding the baby while you pace around the room can help, Gold suggests. Talking to your baby, even though they can’t talk back, can also help your mind stay active and engaged. “When you’re with your baby, try to make eye contact and talk and have physical touch,” Gold says. “That’s what the baby needs — and it’s also what the parent needs.”

If you’re headed back to work after giving birth, it’s wise to give yourself some time to adjust. Ideally, you can go back gradually or part-time until you’re able to balance everything. It can also help to ask for accommodations at work. You may be able to trim your workload, your hours, or both, based on your ADHD diagnosis.

These federal laws are here to support you in the workplace:

• Pregnancy Discrimination Act (PDA): This law protects you from pregnancy-based discrimination at work — regardless of whether you have a disability. It means your employer must give you the same time off as other people with disabilities. They can’t refuse or cut your benefits or pay. And they can’t give you a worse schedule or duties.

• Americans with Disabilities Act (ADA): This law protects people with ADHD and other physical or mental conditions from discrimination. It also gives you a right to reasonable accommodation, like taking frequent short breaks to help with focus.

• Family and Medical Leave Act (FMLA): This law means you can take unpaid leave of up to 12 workweeks per year for certain family and medical reasons while keeping your health insurance and your job. 

Your job and taking care of your baby are both work. And in both cases, being organized is key. Sung suggests starting with the systems that have worked for you in the past. “If your go-to is Post-it notes, then get a big calendar and put Post-it notes all over it,” she says.

Some of the systems or tools that helped you stay on top of things before having a baby may not work afterward. Experiment with new strategies, or tweak old ones, until you find what works for you. 

Gold is a fan of using calendar and reminder apps and setting timers and alarms. You might have an alarm for when to feed the baby. Or a timer to help you remember important calls or appointments. 

Most importantly, ask for help from friends, relatives, and a partner if you have one. “You cannot take care of a baby and a household and do your job alone,” Gold says. 

Be specific with your requests: Can someone help tidy my house on a specific day? Can you watch the baby on Wednesday while I take a walk? 

Sung asks, “What things can you get off your plate so you’re not carrying all the load?” She put her husband in charge of trimming their baby’s nails and giving baths. “You now have 47 more things on your to-do list, so if you can give five of them to someone else, you’re down to 42,” she says.

Staying organized is helpful, but it's also important for new moms with ADHD to stay connected — and to get some fresh air. If you’re feeling overwhelmed, make a date to go to the park. Or take the baby with you on a walk with a friend. It can also be helpful to connect with other new moms who can relate to how you’re feeling.  

ADHD, a condition that makes it harder for some people to pay attention, sit still, or control their impulses, can also make being pregnant more complicated. That’s because pregnancy taxes the very skills that people with ADHD find most difficult, including remembering, organizing, and planning. What’s more, many pregnant people opt to go off their ADHD medication or lower their dose to err on the side of caution, though the drugs are generally considered safe. 

Pregnancy can also worsen ADHD symptoms, mainly because rising hormones can increase fatigue, brain fog, and mood swings. People with ADHD are prone to postpartum depression and anxiety, so it’s important to have someone check in on you. 

Pregnancy is a great time for people with ADHD to lean on a support network of friends, family, neighbors, and co-workers. Counseling and coaching can help. It’s important to have support after the baby is born, too.