What kind of doctor do I need? (adhd + pregnancy)

September 11, 2018 6:19 PM

I'm on a low dose of Adderall. I also plan to start trying to become pregnant in the new year. I'd like to discuss this data with a doctor who's familiar with the latest findings/research and formulate a treatment plan, whether that includes staying on Adderall, switching to another medication, or going off medication. What kind of doctor do I need, an [specialized?] ob-gyn or a [specialized?] psychiatrist? Is there a name for the subspeciality of either field that I should be looking for?

NOTE: I'm aware that current FDA recommendations say to discontinue use during pregnancy, but many women use it nonetheless, and that there is starting to be research on safety based on this observational data.

* I do plan on talking to my current psychiatrist about this, but he's semi-retired and, by his own admission, not up on the latest research. I suspect he will not be helpful here or necessarily have helpful referrals.

* One of the reasons I'm trying to find someone now, is, if I do switch or stop taking medication, I'm not sure how early I need to do it. Is after a positive pregnancy test enough or do I have to do it before we start trying (which could potentially take a long time)? [Not necessarily looking for anecdata, just an example of why I'm asking this now].

* I'm looking for an approach similar to that in "Expecting Better", in terms of the science/reason/non-scare tactics approach.

* Any specific doctor recommendations in the SF Bay Area?

posted by anonymous to Health & Fitness (10 answers total)

Perinatal psychiatrist.

Wife is currently enrolled in a study through Mass. General, may still be taking new patients. (She flew out to Boston for an initial consult for the study because it's important to her, but the rest is done via mail and phone)
posted by AlexiaSky at 6:27 PM on September 11, 2018 [1 favorite]

I am very interested in what you find out. I saw three different doctors and they all recommended that I discontinue Adderall during the pregnancy. The reasoning was that it was Category C, meaning there were side effects but that it wasn't conclusive that they were bad. Essentially, you can't experiment of pregnant ladies. My family care practitioner hyper judgmental when I decided to restart a half dose six weeks postpartum, he was afraid that it might cause poor appetite in my baby. My milk never really came in so I was only comfort nursing anyway My OB/GYN wrote me the script once he made sure that I had a history taking the drug successfully.

Good luck, I hope we get more sound answers in the future!
posted by stormygrey at 6:30 PM on September 11, 2018 [1 favorite]

Stormy, current research is that the amount secreted in brestmilk is negligible at the dose she takes. No one has given her any problems about it.

Wife enrolled in the study , and had a really supportive team here in Chicago regarding her medication use. We were expecting way more push back than we got.

But also, my wifes ADHD is bad enough that driving isn't really safe if she's not on her meds and her functioning absolutely plummets. So her staying on them was important for both developing baby and mom.

So, our anecdotal results of the ADHD meds are mixed (baby was born full term, normal weight) but mom had pre eclampsia and the baby had a NICU stay for ultimately a benign condition.She was also on an SSRI. Because of her age, and that we used IVF (and a donor egg) she was at higher risk for preeclampsia anyway. YMMV.
posted by AlexiaSky at 6:53 PM on September 11, 2018 [1 favorite]

You may also want to work with a clinical pharmacist. There are generalists and people who are board-certified in psychiatric pharmacy or specialize in pharmacy while pregnant or trying to become pregnant. They can examine your specific history and risk factors and suggest specific monitoring to ensure safe drug use for you and your kid. UCSF (and other schools) teaches these things and should have faculty who do it at locations around SF. Maybe start by asking your pharmacist?
posted by holyrood at 7:15 PM on September 11, 2018

If you look within the field of OBGYN, I would speak to a perinatologist (a specialist in maternal-fetal medicine). You may be familiar with them as the doctors for high risk pregnancy.
posted by ocherdraco at 7:21 PM on September 11, 2018

I'd also be interested in what the results of this inquiry are.
posted by k8t at 7:56 PM on September 11, 2018

You want a reproductive psychiatrist. Will be easier to find in cities that have big medical centers.
posted by namemeansgazelle at 8:02 PM on September 11, 2018 [1 favorite]

In the Bay Area, I’d highly recommend Dr. Natalie Rasgon at Stanford’s Center for Neuroscience in Women’s Health. She does perinatal psychiatry and has a background in both psychiatry and obgyn. I saw her for a different condition (OCD) but found the consult with her very helpful and reassuring. It was one long consult rather than a series of appointments, so it was more info for me to take back to my psychiatrist rather than being under her care, but I still found it really helpful. Good luck!
posted by bananacabana at 9:08 PM on September 11, 2018

I had a similar situation and both my normal OB and my psychiatrist worked with me to review recent research and find appropriate options. I don't think you necessarily need a special doctor for this but you do need medical providers who will work with you. Happy to share more details privately if you would like to memail me.
posted by ch1x0r at 4:42 PM on September 12, 2018

AlexiaSky who is your wife's team of specialists in Chicago? I am curious to find a psychiatrist who will help find options to manage ADHD while pregnant.
posted by chicagocharlie at 2:49 PM on January 15, 2019