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ADHD Medication During Pregnancy and Breastfeeding Women suffering from ADHD face a difficult decision about whether to continue or stop taking ADHD medication during pregnancy and breastfeeding. There isn't much information on how long-term exposure to these medications can affect the fetus. A study recently published in Molecular Psychiatry demonstrates that children exposed to ADHD medication during pregnancy do not develop neurological issues such as hearing loss or vision, febrile seizures, or IQ impairment. The authors acknowledge the need for higher-quality research. Risk/Benefit Analysis Women who are pregnant and take ADHD medication should evaluate the benefits of using it versus the dangers for the foetus. Physicians don't have the data to make unambiguous recommendations but they can provide information on risks and benefits to assist pregnant women to make an informed decision. A study published in Molecular Psychiatry concluded that women who took ADHD medication during their early pregnancy did not have a greater risk of fetal malformations or structural birth defects. The researchers used a large population-based case-control study to assess the risk of major structural birth defects in infants born to mothers who had taken stimulants in early pregnancy, and those who did not. Clinical geneticists and pediatric cardiologists examined the cases to ensure accurate case classification and to limit the chance of bias. The research conducted by the researchers was not without limitations. The researchers were unable to, in the first place to differentiate the effects triggered by the medication from the disorder. This limitation makes it difficult to know whether the small differences observed in the groups that were exposed are due to the use of medication or comorbidities that cause confusion. The researchers did not study the long-term effects for the offspring. The study revealed that infants whose mother had taken ADHD medication during pregnancy were at a slightly greater risk of being admitted to the neonatal care unit (NICU), compared to those whose mothers did not use any medication during pregnancy, or had discontinued taking their medication prior to or during pregnancy. This was due to central nervous system disorders, and the higher risk of admission was not found to be affected by the type of stimulant medication was used during pregnancy. Women who used stimulant ADHD medication during pregnancy also had an increased risk of having a caesarean section or having a baby with a low Apgar score (less than 7). These risks did not appear to be influenced by the kind of medication used during pregnancy. Researchers suggest that the small risk of using ADHD medications in early pregnancies can be offset by greater benefits for baby and mother of continued treatment for the woman's disorder. Physicians should discuss this with their patients and, if possible, help them develop strategies for improving their coping skills which can reduce the impact of her disorder on her daily functioning and relationships. Medication Interactions As more women than ever before are being diagnosed with ADHD and treated with medication, the question of whether or not to end treatment during pregnancy is one that doctors are having to face. Often, these decisions are made in the absence of any evidence that is clear and definitive in either case, which means that doctors must weigh what they know from their own experiences, those of other doctors, and what the research suggests about the subject, along with their own judgments for each patient. Particularly, the issue of potential risks for the baby can be tricky. A lot of studies on this topic are based on observations rather than controlled research, and their findings are often contradictory. Additionally, the majority of studies limit their analysis to live births, which may undervalue the serious teratogenic effects that can cause abortion or termination of the pregnancy. The study presented in this journal club addresses these shortcomings by analyzing data on live and deceased births. Conclusion A few studies have revealed an association between ADHD medications and certain birth defects, other studies have not shown such a relationship. The majority of studies show a neutral, or even slight negative impact. Therefore an accurate risk-benefit analysis is required in every instance. For women suffering from ADHD and ADD, the decision to stop taking medication is difficult if not impossible. In a recent piece published in Archives of Women's Mental Health by psychologist Jennifer Russell, she notes that stopping ADHD medications during pregnancy can cause depression and feelings of loneliness. A decrease in medication could also affect the ability to drive safely and to perform work-related tasks which are essential aspects of normal life for people with ADHD. She suggests that women who aren't sure whether to take the medication or stop it due to their pregnancy, educate their family members, coworkers and acquaintances about the condition, its effects on daily functioning, and the benefits of keeping the current treatment regimen. add medication adult will also help a woman feel supported in her decision. Some medications can pass through the placenta. If a woman decides to not take her ADHD medication while pregnant and breastfeeding, it is crucial to be aware that the drug may be transferred to her baby. Birth Defects Risk As the use of ADHD drugs to treat symptoms of attention deficit hyperactivity disorder (ADHD) increases as do concerns about the effects that the drugs could have on the fetuses. A study that was published in the journal Molecular Psychiatry adds to the existing knowledge on this subject. Researchers used two massive datasets to analyze over 4.3 million pregnant women and determine if stimulant medication use increased birth defects. Researchers discovered that, while the risk overall is low, the first trimester ADHD medication use was associated with slightly higher risk of specific heart defects like ventriculoseptal defects. The researchers of the study could not discover any link between early medication usage and other congenital anomalies such as facial deformities or club feet. The results are in agreement with previous studies that showed the existence of a slight, but significant increase in the number of cardiac malformations among women who started taking ADHD medication prior to the time of pregnancy. This risk increased during the latter part of pregnancy when many women stopped taking their medication. Women who used ADHD medication in the first trimester of their pregnancies were also more likely to undergo caesarean sections, a low Apgar score following delivery, and a baby who needed breathing assistance during birth. The authors of the study were not able to eliminate bias due to selection because they limited their study to women with no other medical conditions that could have contributed to the findings. The researchers hope that their research will serve to inform the clinical decisions of physicians who encounter pregnant women. They advise that while discussing the benefits and risks is important, the decision to stop or keep medication should be based on each woman's requirements and the severity of her ADHD symptoms. The authors caution that, while stopping the medication is a possibility to look into, it is not recommended due to the high rate depression and other mental problems among women who are pregnant or recently gave birth. Further, the research suggests that women who decide to stop taking their medications are more likely to experience difficulties adjusting to life without them following the baby's arrival. Nursing The responsibilities of being a new mother can be overwhelming. Women with ADHD who have to deal with their symptoms while attending doctor appointments as well as making preparations for the arrival of a baby and getting used to new routines at home are often faced with a number of difficulties. This is why many women choose to continue taking their ADHD medication throughout the pregnancy. The risk to a nursing infant is low because the majority of stimulant medication is absorbed through breast milk at a low level. The rate of exposure to medication can vary depending upon the dosage the medication is administered, its frequency and time of day. Additionally, individual medications enter the baby's system differently through the gastrointestinal tract and breast milk and the impact of this on a newborn infant is not yet fully known. Some doctors may decide to stop stimulant medication during a woman's pregnancy due to the absence of research. This is a difficult decision for the woman, who must weigh the advantages of taking her medication as well as the risk to the embryo. In the meantime, until more information is available, doctors should ask all pregnant patients about their experience with ADHD and if they are taking or planning to take medication during the perinatal time. A increasing number of studies have proven that most women can safely continue their ADHD medication during pregnancy and breastfeeding. This has led to an increasing number of patients choose to do so and in consultation with their doctor they have discovered that the benefits of maintaining their current medication far outweigh any risks. Women with ADHD who plan to breastfeed should seek the advice of a specialist psychiatrist before becoming pregnant. They should discuss their medication with their doctor as well as the pros and cons for continuing treatment. This includes non-pharmacological strategies. Psychoeducation should also be provided to help women with ADHD be aware of their symptoms and underlying disorder, learn about available treatment options and reinforce existing strategies for coping. This should be a multidisciplinary approach including obstetricians, GPs, and psychiatrists. Pregnancy counseling should include discussion of a treatment plan for the mother and the child, as well as monitoring for signs of deterioration, and, if necessary adjustments to the medication regimen.