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ADHD Medication During Pregnancy and Breastfeeding The choice of whether to stop or continue ADHD medications during pregnancy and breastfeeding is a difficult decision for women suffering from the condition. There are few data on how exposure to ADHD for a long time could affect a fetus. A recent study published in Molecular Psychiatry demonstrates that children exposed to ADHD medication during pregnancy do not develop neurological disorders such as impaired hearing or vision, febrile seizures or IQ impairment. The authors acknowledge that more high quality studies are needed. Risk/Benefit Analysis Pregnant women who take ADHD medications need to balance the benefits of using them against the risks to the fetus. The doctors don't have the information to give clear advice but they can provide information on risks and benefits to aid pregnant women in making informed choices. A study published in Molecular Psychiatry concluded that women who took ADHD medication during early pregnancy were not at a greater risk of fetal malformations or structural birth defects. The researchers used a large, population-based case-control study to evaluate the incidence of major structural birth defects in babies born to mothers who took stimulants during early pregnancy and those who had not. Pediatric cardiologists, clinical geneticists and other experts reviewed the cases in order to make sure that the classification was accurate and to minimize any bias. The research conducted by the researchers was not without limitations. The most important issue was that they were not able to differentiate the effects of the medication from the effects of the disorder at hand. This limitation makes it difficult to determine whether the small associations observed in the exposed groups result from medication use or comorbidities that cause confusion. Researchers also did not study long-term outcomes for the offspring. The study showed that infants whose mothers took ADHD medication during pregnancy had a greater risk of being admitted to the neonatal care unit (NICU) in comparison to those whose mothers didn't take any medication during pregnancy or discontinued taking their medication prior to or during pregnancy. This was due to central nervous system disorders, and the higher risk of admission did not appear to be influenced by which stimulant medications were used during pregnancy. Women who took stimulant ADHD medications during pregnancy also had a higher chance of having an emergency caesarean section or having a baby that scored low on the Apgar scale (less than 7). These increases did appear to be independent of the type of medication taken during pregnancy. The researchers suggest that the risk of a small amount with the use of ADHD medications during early pregnancy could be offset by the greater benefits to both the mother and child from continued treatment for the woman's condition. Doctors should discuss with their patients about this issue and, if possible, help them improve coping skills which may reduce the effects of her disorder on her daily functioning and her relationships. Medication Interactions As more women than ever are diagnosed with ADHD and treated with medication, the issue of whether to keep or stop treatment during pregnancy is one that doctors are having to confront. These decisions are frequently taken without clear and authoritative evidence. Instead, doctors must take into account their own experience in conjunction with the experiences of other physicians and the research on the topic. The issue of risk to infants is particularly tricky. Many studies on this subject are based on observational data rather than controlled research and their findings are often contradictory. In addition, most studies limit their analysis to live births, which may undervalue the serious teratogenic effects that can result in abortion or termination of the pregnancy. The study discussed in the journal club addresses these issues by analyzing information on deceased and live births. The conclusion: While some studies have found that there is a positive correlation between ADHD medications and the risk of certain birth defects, other studies have found no connection, and most studies demonstrate a neutral or slightly negative impact. In each case an in-depth evaluation of the risks and benefits is required. For many women with ADHD who suffer from ADHD, the decision to stop medication is difficult if not impossible. In a recent article in Archives of Women's Mental Health by psychologist Jennifer Russell, she notes that stopping ADHD medications during pregnancy can increase depression and feelings of being isolated. The loss of medication can also affect the ability to safely drive and perform work-related tasks, which are vital aspects of daily life for those with ADHD. She suggests that women who are unsure whether to continue taking medication or discontinue it due to pregnancy should educate family members, colleagues, and acquaintances about the condition, its effects on daily functioning, and the benefits of continuing the current treatment regimen. Educating them can also make the woman feel more comfortable in her struggle with her decision. adult add medications is also worth noting that certain drugs can pass through the placenta so if the patient decides to stop her ADHD medication during pregnancy and breastfeeding, she should be aware that traces of the drug can be passed on to the baby. Birth Defects Risk As the use and use of ADHD drugs to treat symptoms of attention deficit hyperactivity disorder (ADHD), increases, so does concern about the possible effects of the drugs on foetuses. A recent study published in the journal Molecular Psychiatry adds to the body of knowledge about this subject. Researchers utilized two massive data sets to study over 4.3 million pregnancy and determine if stimulant medication use caused birth defects. Researchers found that while the risk overall is low, the first trimester ADHD medication exposure was associated with slightly higher rates of specific heart defects such as ventriculoseptal defect. The researchers of the study found no link between early medication use and congenital abnormalities like facial clefting, or club foot. The results are consistent with previous studies that have shown a small but significant increase in the risk of developing cardiac malformations among women who began taking ADHD medications prior to the time of the birth of their child. This risk increased during the latter part of pregnancy, when a lot of women began to stop taking their medication. Women who were taking ADHD medication in the first trimester were more likely require a caesarean birth, have an insufficient Apgar after delivery, and have a baby who needed help breathing at birth. However the authors of the study were not able to eliminate selection bias by restricting the study to women who did not have any other medical issues that could have contributed to the findings. Researchers hope their research will help doctors when they see pregnant women. The researchers suggest that while discussing the risks and benefits are important, the decision on whether to continue or stop medication should be made according to the severity of each woman's ADHD symptoms and her needs. The authors also advise that even though stopping the medication is an alternative, it is not an option to consider due to the high rate of depression and other mental health problems among women who are pregnant or post-partum. Additionally, research suggests that women who stop taking their medications will have a tough transitioning to life without them once the baby is born. Nursing The responsibilities of being a new mother can be overwhelming. Women with ADHD are often faced with a number of difficulties when they must deal with their symptoms, attend doctor appointments and prepare for the birth of their child and adjust to a new routine. Many women choose to continue taking their ADHD medication during pregnancy. The risk for breastfeeding infant is not too high since the majority of stimulant medication passes through breast milk at a low level. However, the amount of exposure to medication by the infant can differ based on dosage, how often it is taken and the time of day it is administered. Additionally, individual medications enter the body of the baby differently through the gastrointestinal tract as well as breast milk and the impact of this on a newborn is not well known. Some doctors may decide to stop stimulant medications during a woman's pregnancy due to the lack of research. This is a difficult choice for the patient, who must balance the benefit of continuing her medication with the potential dangers to the foetus. Until more information is available, doctors should inquire with all pregnant patients about their experience with ADHD and whether they are taking or planning to take medication during the perinatal period. A growing number of studies have revealed that most women can safely continue to take their ADHD medication during pregnancy and while breastfeeding. In response, a growing number of patients are choosing to continue their medication. They have found after consulting with their doctors, that the benefits of keeping their current medication outweigh any risk. Women who suffer from ADHD who are planning to nurse should seek the advice of a specialist psychiatrist before becoming pregnant. They should discuss the medication they are taking with their physician and discuss the pros and cons of continuing treatment. This includes non-pharmacological methods. Psychoeducation is also needed to help pregnant women with ADHD be aware of the symptoms and the underlying disorder. They should also be informed about treatment options and reinforce coping mechanisms. This should be a multidisciplinary process together with obstetricians, GPs and psychiatry. Pregnancy counseling should consist of a discussion of a treatment plan for the mother and the child, and monitoring for signs of deterioration and, if necessary adjustments to the medication regimen.