46 I am a law student treated with amphetamines for attention deficit hyperactive disorder (ADHD): can I breastfeed my child? A pilot study

Introduction In recent years, there has been a steady increase in ADHD medication use by young adults, including women of childbearing age and during pregnancy. Most data on the safety of these medications is from recreational abuse of methamphetamine. Little is known on the safety of amphetamine stimulants for ADHD treatment during breastfeeding. Amphetamines are excreted into human milk and may be found in the urine of nursing infants. Poor sleeping and irritability have been reported in some nursing infants, but long-term developmental effects were not described. Methods A prospective pilot study of women who approached the TIS Zerifin between the years 2017–2022 for information on the safety of the use of amphetamine stimulants – lisdexamphetamine or mixed racemic amphetamine salts (Adderall®) during breastfeeding. A telephone follow-up interview was conducted to assess the outcome and the neurodevelopment of the children by using Pediatric Quality of Life (PedsQL), and Denver Developmental Scale. Results Thirteen women were included in the analysis, 6 (46%) exposed to lisdexamphetamine, and 7 (54%) to mix racemic amphetamine salts. Mean maternal age at the time of the first contact was 32±5.8 years. Most of the women had a high academic education (11/13, 85%). Seven women used amphetamines during pregnancy, and 4/13 (31%) were exposed throughout pregnancy. Three (23%) women used concomitant psychotropic medications. Median (IQR) age of the child at the follow-up was 18 (5.25–34) months. Nine (69%) children were fully breastfed. Adverse effects were reported among five (38%) children: somnolence (1, 8%), crying/restlessness (3, 23%), GI effects (colic/constipation) – 4, 31%. All children were reported to have normal gross motor development, based on Denver developmental scale. Neurodevelopment, as measured by PEDsQL, were also normal with PEDsQL score (median, IQR): total 97.16 (91.48–100), Psychosocial Health 99.33 (94.83–100), Physical Health 98.75 (87.8–100). Conclusions Exposure to amphetamine stimulants during breastfeeding was not associated with negative neurodevelopment of the offspring. However, due to the small sample size, further studies are needed in order to conclude on the effect of prolonged exposure to amphetamine stimulants during breastfeeding.