Postpartum Care for Mothers with ADHD: A Guide for Clinicians
To better serve postpartum mothers with ADHD, clinicians should understand the unique facets of ADHD in women, how symptoms change in the weeks after childbirth, and how to help new parents make decisions around medication use and ADHD symptom management.
New mothers with ADHD face distinct postpartum challenges that are as ubiquitous as they are unstudied. Despite the executive functioning strains exacerbated by ADHD medication cessation during pregnancy and nursing, postpartum women must learn to provide steady care for their newborns. All the while, hormonal changes cause ADHD symptoms to spike and mental health and wellbeing to plummet. The months following the birth of a baby are uniquely difficult, and women with ADHD do not usually receive the medical support and treatments they need during this time.
Supporting new parents with ADHD in this sensitive phase is of utmost clinical importance.
The Postpartum Period: What New Mothers with ADHD Face
Clinicians must understand the demands of early motherhood through the lens of ADHD symptoms and management. These include:
- Hormonal swings. When estrogen levels drop in the postpartum period, new mothers are more likely to experience mood swings, irritability, sleep disturbances, and other cognitive problems, presenting an added burden for those with ADHD.
- Negative feelings. Many women with ADHD have had negative views of their self-worth and self-esteem long before giving birth.1 2 These feelings can intensify when executive functioning deficits collide with the relentless demands of caring for a newborn. Studies show that challenges stemming from ADHD are linked to less positive parenting, greater over-reactivity with children, lower parental control, and other parenting difficulties.3
In an ADDitude survey of 1,914 women with ADHD, more than half of those who had given birth said they experienced symptoms of postpartum depression (PPD), including feelings of worthlessness (76%), crying spells (76%), mood swings (66%), and irritability (62%), among other symptoms.
[Take This Self-Test: Signs of Postpartum Depression]
The survey, conducted in 2023, also found that nearly half of all women with self-reported PPD said they did not receive any treatment, and nearly 18% said their symptoms lasted longer than two years.
Here are a few comments from ADDitude readers who answered the survey:
“The medical community didn’t take my baby blues seriously after my children were born. They said I just ‘needed to exercise, lose the rest of the baby weight, and focus on my family.’ Then I would be all better.”
“No one talked about it, and my doctor never asked how I was doing. So, I assumed I was weak.”
“My ADHD got significantly worse. I felt overwhelmed and was not supported by my husband.”
“Something in me changed after giving birth. My doctors told me it was anxiety and hormones. I could not shut down my racing mind. I was constantly irritable, impatient, and a complete space cadet.”
[Get This Free Download: The Facts About Major Depressive Disorder in Women]
The Postpartum Period with ADHD: Clinical Implications and Treatment Considerations
The postpartum period is an inflection point that requires an individualized treatment plan based on the specific needs of each patient with ADHD. Considerations include:
ADHD medications and breastfeeding. Though a recent study found that in-utero exposure to medication for ADHD, including stimulants, did not impair a child’s neurodevelopment4, it is unclear whether it is safe for a new parent to take ADHD medication while breastfeeding. What we know about medication transfer into breast milk is limited to case reports and case series data, which show that the relative dose of amphetamine or methylphenidate derivatives in breast milk is very low — in many cases less than 1%, when less than 10% is considered low5 6. Overall, this is reassuring data when, historically, the default medical position has been to interrupt a mother’s “non-essential pharmacologic treatment” during breastfeeding. A patient’s improved functioning on ADHD medication should be weighed against potential risks that medication in breast milk might pose.
Strategies to enhance wellbeing. It’s important to encourage postpartum women to get regular exercise, sufficient sleep, and proper nutrition. Emphasize the importance of seeking support at home, spending time in nature, and doing other stress-reducing activities. Cognitive behavioral therapy for ADHD should also be recommended.
Facilitating a team approach. Through the acute postpartum period and well into parenthood, patients with ADHD can benefit from working with an integrated, supportive, and informed healthcare team that understands the impact of hormones on ADHD and the ways in which they interact with medication. Our website, womensmentalhealth.org, is a great resource for patients and clinicians looking to improve their knowledge on women’s mental health across the life cycle. The site provides current information on research findings and explains how these inform day-to-day clinical practice.
Postpartum Care and ADHD: Next Steps
- Read: Treating for Two — ADHD Meds in Pregnancy
- Read: A Self-Care Guide for Moms with ADHD Raising Kids with ADHD
- Read: Bringing Up Baby — Motherhood with ADHD
Allison S. Baker, M.D., is a clinician, researcher, and educator with the Perinatal and Reproductive Psychiatry Clinical Research Program at Massachusetts General Hospital.
The content for this article was derived from the ADDitude ADHD Experts webinar titled, “ADHD, Pregnancy, and Motherhood: A Practical Guide for Hopeful Parents” [Video Replay & Podcast #454] with Allison Baker, M.D., which was broadcast on May 11, 2023.
View Article Sources
1 Quinn, P. O., & Madhoo, M. (2014). A review of attention-deficit/hyperactivity disorder in women and girls: uncovering this hidden diagnosis. The Primary Care Companion for CNS disorders, 16(3), PCC.13r01596. https://doi.org/10.4088/PCC.13r01596
2 Arcia, E., & Conners, C. K. (1998). Gender differences in ADHD?. Journal of Developmental and Behavioral Pediatrics : JDBP, 19(2), 77–83. https://doi.org/10.1097/00004703-199804000-00003
3 Park, J. L., Hudec, K. L., & Johnston, C. (2017). Parental ADHD symptoms and parenting behaviors: A meta-analytic review. Clinical psychology review, 56, 25–39. https://doi.org/10.1016/j.cpr.2017.05.003
4 Bang Madsen, K., Robakis, T. K., Liu, X., Momen, N., Larsson, H., Dreier, J. W., Kildegaard, H., Groth, J. B., Newcorn, J. H., Hove Thomsen, P., Munk-Olsen, T., & Bergink, V. (2023). In utero exposure to ADHD medication and long-term offspring outcomes. Molecular psychiatry, 28(4), 1739–1746. https://doi.org/10.1038/s41380-023-01992-6
5 Marchese, M., Koren, G., & Bozzo, P. (2015). Is it safe to breastfeed while taking methylphenidate?. Canadian Family Physician Medecin de Fmille Canadien, 61(9), 765–766.
6 Ilett, K. F., Hackett, L. P., Kristensen, J. H., & Kohan, R. (2007). Transfer of dexamphetamine into breast milk during treatment for attention deficit hyperactivity disorder. British journal of clinical pharmacology, 63(3), 371–375. https://doi.org/10.1111/j.1365-2125.2006.02767.x
