Dexamfetamine & Lisdexamfetamine in Pregnancy and Breastfeeding Handy Fact Sheet

Key points (at a glance)

• Planning is best — talk to your prescriber before trying for a baby.

• For many, staying on treatment is safer than letting ADHD symptoms flare.

• Current evidence does not show an increased risk of major birth defects with therapeutic amphetamine use for ADHD.

• Breastfeeding is usually compatible with careful dosing and baby monitoring.

• Always make changes with your prescriber, not on your own.

Thinking about starting a family?

• Plan ahead with your prescriber. ADHD medicines don’t appear to affect fertility.

• Options to discuss:

  • Continue your current medicine and monitor closely

  • Lower the dose if appropriate (only with medical advice)

  • Consider alternatives if risks/benefits favour a switch

  • Stop non-essential medicines to reduce overall risk

• Big picture: if medication keeps you safe, focused, and well, continuing may be safer than unmanaged ADHD.

Just found out you’re pregnant?

• Don’t stop suddenly. Your baby has already been exposed; stopping abruptly can cause rebound symptoms (fatigue, low mood, hyperactivity, increased appetite).

• Speak to your prescriber in 1–2 days to agree a plan. You may choose to continue, reduce, or taper over weeks if appropriate.

• Remember: untreated ADHD can raise risks (e.g., poor sleep, missed appointments, accidents, or risky choices like smoking/alcohol). Staying well matters for you and baby.

Early pregnancy (first 3 months)

• Lisdexamfetamine converts to dexamfetamine, which crosses the placenta.

• Therapeutic amphetamine use for ADHD has not been linked with increased risk of:

  • Major congenital malformations overall

  • Cardiac malformations overall

• No clear data on miscarriage risk. Some older data involve illicit amphetamine use (not the same as prescribed ADHD treatment).

Later pregnancy (months 4–9)

• Normal body changes (weight, fluid, liver/kidney function) can alter how medicines work.

  • If ADHD symptoms break through, see your prescriber — a dose review may help.

• Preterm birth: some studies suggest a small increase (e.g., ~10% vs background ~7.5%), while others do not. Your team will factor your overall risks.

Around delivery

• Place of birth is based on your overall pregnancy health.

• Newborn withdrawal-type symptoms are possible with medicines acting on the brain (restlessness, irritability, poor feeding), though data are limited. Hospital teams will monitor baby if needed.

Breastfeeding

• Dexamfetamine/lisdexamfetamine are likely compatible with breastfeeding.

• Aim for the lowest effective dose.

• Watch baby for: irritability, poor sleep, poor feeding, or poor weight gain.

  • If these occur, seek advice quickly and consider pausing breastfeeding while reviewed.

• If baby is preterm or has health issues, get specialist advice first.

• Rare reports of prolactin effects exist, but milk supply was not reduced in mothers treated for ADHD.

Long-term child development

• Limited medicine-specific data, but a large study following children exposed to ADHD medication in pregnancy (including dexamfetamine/lisdexamfetamine) did not find increased risks of: developmental delay, autism, ADHD, vision/hearing problems, epilepsy, or growth problems into later childhood/early adulthood.

Looking after yourself in pregnancy

• Only take medicines you need. Check all over-the-counter products with a pharmacist first.

• Folic acid, vitamin D, iron if advised by your clinician.

• Balanced diet, regular gentle exercise, and good hydration.

• If you have nausea/vomiting, seek treatment early to avoid dehydration.

• Build a support network to help spot early struggles and keep routines steady.

When to get help urgently

• You feel unable to cope or notice risk-taking increasing

• Severe mood changes, persistent palpitations, chest pain, or fainting

• Baby shows poor feeding, excessive sleepiness, or not gaining weight (while you’re breastfeeding)

Shared decision-making

There is no one “right” answer for everyone. The best plan balances:

• Your ADHD symptom control and safety

• Pregnancy and newborn considerations

• Your personal values and support at home/work

Next step: book a review with your prescriber to agree a plan that keeps you and baby safe and well.