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Amphetamines 

From: Exposure to Psychotropic Medications and Other Substances during Pregnancy and Lactation: A Handbook for Health Care Providers

Examples

Amphetamine, dextroamphetamine (Dexedrine), methylphenidate (Ritalin), methamphetamine

Street names

Speed, bennies, glass, crank, pep pills, uppers, meth (also used to refer to methadone), chalk, ice, crystal, crystal meth, jib

Amphetamines are stimulant drugs used to treat such disorders as attention-deficit/hyperactivity disorder, narcolepsy and refractory depression. When amphetamines are used therapeutically, they are ingested orally. However, when they are abused, they can not only be ingested orally, but also snorted, smoked (e.g., crystal meth) or injected.

Summary and Recommendations

  • If the benefits outweigh potential risks, therapeutic use of amphetamines at the lowest dose possible may be continued during pregnancy. However, amphetamine use during pregnancy at higher-than-recommended dosages, or abuse of amphetamines, are not recommended.
  • Even if a woman is abusing amphetamines, it is important to provide her with non-judgmental support and to keep her with her baby. There is no clinical reason to keep the baby away from the mother and there are known benefits of keeping mother and child together.
  • Careful monitoring of the neonates of mothers who used amphetamines while pregnant is recommended, and may need to continue longer than for babies born to mothers who used cocaine while pregnant (methamphetamine, in particular, has a long half-life). Comfort measures—especially touch, reduced stimulation (e.g., a quiet room with dim lighting) and breastfeeding—are generally sufficient to care for these babies. There is no pharmacological treatment for babies exposed to the mother’s prenatal amphetamine use.
  • Discuss with the mother the risks of breastfeeding while using amphetamines and the overall benefits of breastfeeding. Use of amphetamines should not necessarily be considered contraindicated during breastfeeding.
  • Concerning crystal meth use, the baby’s environment must be monitored to ensure the child is not exposed to a high-risk lifestyle (e.g., to the dangers of a crystal meth lab in the home).

Fetal effects

Amphetamines are known to constrict blood flow to the placenta, which reduces oxygen flow to the developing fetus. Data from human and animal studies about the effects of amphetamine exposure on the fetus are inconclusive.1

Studies suggest that problematic methamphetamine use by a woman during pregnancy may cause premature delivery and low-birth-weight babies; however, study confounders (e.g., multiple drug use) make forming a definite conclusion impossible. A thorough medical exam is necessary to exclude other medical conditions.

One study showed a correlation between women’s methamphetamine use and low birth weight, but revealed no differences in head circumference, Apgar scores or gestational age as compared to controls.2 Another study showed that babies born to mothers who abused methamphetamine had a significant decrease in gestational age, birth weight, length and head circumference.3 A third study found that the methamphetamine-exposed group was 3.5 times more likely to be small for gestational age than the unexposed group.4

Major malformations

Amphetamines do not appear to be human teratogens, especially when used within a therapeutic context.5-7

Spontaneous abortion

Amphetamines may increase the risks of maternal hypertension, possibly leading to spontaneous abortion, but this has not been reported in the literature.

Neonatal effects

Neonatal withdrawal symptoms, which include shrill cries, irritability, jerking, sneezing, poor feeding, tremors and hypertonia, have been reported.3,8 These babies may need increased medical support (e.g., repeated suctioning, oxygen, ventilation) immediately after delivery.

Long-term effects on the child

One study followed 66 infants of mothers who were addicted to amphetamines during pregnancy. These infants experienced some drowsiness in the first few months, but presented normal somatic and psychomotor development at one year of age.9

Breastfeeding

Amphetamines are excreted into breast milk and have been found in the urine of breastfeeding infants;10 however, no adverse effects were observed in neonates during the first two years of observation. The American Academy of Pediatrics states that breastfeeding and amphetamine abuse are contraindicated, though this recommendation is not based on published data. Taking stimulants may cause irritability and poor sleeping patterns in the baby; however, there is no known data on this, and the percentage of the dose that enters breast milk is unknown. A recent report of prescribed methylphenidate use by the mother during breastfeeding measured the baby’s dose as 0.2 per cent of the mother’s dose.11

Withdrawal effects on the mother

Symptoms of withdrawal may include fatigue, nightmares, insomnia, increased appetite, psychomotor agitation or retardation, and dysphoric mood. Withdrawal from amphetamines is primarily a psychological process, and can be safely undertaken. Women should be provided supportive care and monitored for suicidal ideation.

Effects of untreated illness

While the effects of untreated adhd during pregnancy specifically have not been studied, it has been shown that people with untreated adhd are more likely to self-medicate through substance abuse.12 Depending on the severity of the symptoms, treatment through behavioural and other non-pharmacological therapies should be considered. In the case of more severe symptoms—those that could put the mother’s health and safety at risk—and concomitant anxiety and depression, the risks of controlled amphetamine use may be considered acceptable.

References

  1. U.S. Department of Health and Human Services, National Toxicology Program, Center for the Evaluation of Risks to Human Reproduction. (2005). NTP-CERHR Monograph on the Potential Human Reproductive and Developmental Effects of Amphetamines (NIH Publication No. 05-4474). Research Triangle Park, NC: Author. Available: http://cerhr.niehs.nih.gov/chemicals/stimulants/ amphetamines/AmphetamineMonograph.pdf. Accessed July 11, 2007.
  2. Ramin, S.M., Little, B.B., Trimmer, K.J., Standard, D.I., Blakely, C.A. & Snell, L.M. (1992). Methamphetamine use during pregnancy in a large urban population [Abstract]. American Journal of Obstetrics and Gynecology, 166, 353.
  3. Oro, A.S. & Dixon, S.D. (1987). Perinatal cocaine and methamphetamine exposure: Maternal and neonatal correlates. Journal of Pediatrics, 111 (4), 571–578.
  4. Smith, L.M., LaGasse, L.L., Derauf, C., Grant, P., Shah, R., Arria, A. et al. (2006). The infant development, environment, and lifestyle study: Effects of prenatal methamphetamine exposure, polydrug exposure, and poverty on intrauterine growth. Pediatrics, 118 (3), 1149–1156.
  5. Chernoff, G.F. & Jones, K.L. (1981). Fetal preventive medicine: Teratogens and the unborn baby. Pediatric Annals, 10 (6), 210–217.
  6. Kalter, H. & Warkany, J. (1983). Congenital malformations (second of two parts). New England Journal of Medicine, 308 (9), 491–497.
  7. Zierler, S. (1985). Maternal drugs and congenital heart disease. Obstetrics and Gynecology, 65 (2), 155–165.
  8. Sussman, S. (1963). Narcotic and methamphetamine use during pregnancy: Effect on newborn infants. American Journal of Diseases of Children, 106, 325–330.
  9. Billing, L., Eriksson, M., Larsson, G.E. & Zetterström, R. (1980). Amphetamine addiction and pregnancy III: One year follow-up of the children—Psychosocial and pediatric aspects. Acta Paediatrica Scandinavica, 69 (5), 675–680.
  10. Steiner, E., Villén, T., Hallberg, M. & Rane, A. (1984). Amphetamine secretion in breast milk. European Journal of Clinical Pharmacology, 27 (1), 123–124.
  11. Hackett, L.P., Kristensen, J.H., Hale, T.W., Paterson, R. & Ilett, K.F. (2006). Methylphenidate and breast-feeding. Annals of Pharmacotherapy, 40 (10), 1890–1891.
  12. Kalbag, A.S. & Levin, F.R. (2005). Adult adhd and substance abuse: Diagnestic and treatment issues. Substance Use & Misuse, 40 (13 & 14), 1955–1981.

Exposure to Psychotropic Medications and Other Substances during Pregnancy and Lactation: A Handbook for Health Care Providers

General issues and background

Psychotropic medications and other substances: Properties, effects and recommendations

Resources

Index of drugs

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