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ADHD Medication During Pregnancy and Breastfeeding Women with ADHD face a difficult decision on whether to keep or stop taking ADHD medication during pregnancy and breastfeeding. There is a lack of information about how long-term exposure to these drugs may affect the foetus. A study recently published in Molecular Psychiatry demonstrates that children exposed to ADHD medication during pregnancy do not develop neurological issues like hearing loss or vision, febrile seizures or IQ impairment. The authors acknowledge the need for more high-quality research. Risk/Benefit Analysis Women who are expecting and taking ADHD medication should consider the benefits of taking it against the potential dangers for the fetus. Doctors don't have enough data to provide clear recommendations but they can provide information on the risks and benefits to help pregnant women make informed choices. A study published in Molecular Psychiatry concluded that women who took ADHD medication during their early pregnancy were not at a higher risk of fetal malformations or structural birth defects. Researchers conducted a large population-based study of case control to compare the incidence of structural defects that were major in infants who were born to mothers who were taking stimulants during pregnancy. Clinical geneticists, pediatric cardiologists and other experts reviewed the cases in order to make sure that the classification was accurate and to minimize any bias. However, the researchers' study had its limitations. The researchers were unable in the beginning, to separate the effects of the medication from the disorder. This makes it difficult for researchers to establish whether the small differences observed between the exposed groups were due to the use of medication or if they were caused by co-morbidities. The researchers did not look at the long-term effects for the offspring. The study showed that babies whose mothers had taken ADHD medication during pregnancy had a greater risk of being admitted to the neonatal care unit (NICU) as 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-related disorders and the increased risk for admission was not found to be affected by the type of stimulant medications were taken during pregnancy. Women who were taking stimulant ADHD medications during pregnancy also had a higher likelihood of having an emergency caesarean section or having one whose baby scored low on the Apgar scale (less than 7). These increases did appear to be independent of the type of medication taken during pregnancy. Researchers suggest that the minor risks posed by the use of ADHD medications in early pregnancies may be offset by the more beneficial outcomes for both mother and baby of continuing treatment for the woman's disorder. Physicians should talk to their patients about this and try to help them improve coping skills which could reduce the effects of her disorder on her daily life and relationships. Medication Interactions Many doctors are faced with the decision of whether to keep treatment or stop as more women are diagnosed with ADHD. Most of the time, these decisions are made without any evidence that is clear and definitive either way, so physicians have to weigh their experience, the experiences of other doctors, and what the research suggests about the subject and their own judgments for each individual patient. Particularly, the issue of possible risks to the infant can be difficult. Discover More Here on this issue is based on observation rather than controlled studies and the results are in conflict. The majority of studies limit their analysis to live-births, which could underestimate the teratogenic impact leading to abortions or terminations of pregnancy. The study that is discussed in this journal club addresses these issues by looking at data from both live and deceased births. Conclusion A few studies have revealed an association between ADHD medications and certain birth defects however, other studies haven't shown such a relationship. The majority of studies show a neutral, or even slight negative impact. In each case an in-depth analysis of the potential risks and benefits is required. It can be difficult, if not impossible, for women suffering from ADHD to stop taking their medication. In a recent article published 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 isolation. Additionally, the loss of medication can interfere with the ability to perform job-related tasks and drive safely that are crucial aspects of daily life for many people with ADHD. She recommends that women who are unsure about whether to continue or stop taking medication because of their pregnancy consider informing family members, friends, and coworkers on the condition, its effects on daily life, and the advantages of staying on the current treatment regimen. It can also help a woman feel supported in her decision. It is important to remember that some medications are able to pass through the placenta so if the patient decides to stop taking her ADHD medication during pregnancy and breastfeeding, she should be aware that traces of the drug can be transferred to the infant. Risk of Birth Defects As the use and use of ADHD medications to treat the symptoms of attention deficit hyperactivity disorder (ADHD) is increasing the concern over the potential effects of these drugs on foetuses. A recent study published in the journal Molecular Psychiatry adds to the existing knowledge about this subject. Using two massive data sets researchers were able to analyze more than 4.3 million pregnancies and determine whether the use of stimulant medications increased the risk of birth defects. While the overall risk is low, the researchers did find that first-trimester exposure to ADHD medications was associated with an increased risk of certain heart defects, like ventriculo-septal defects (VSD). The researchers of the study found no link between early medication use and other congenital abnormalities, like facial clefting, or club foot. The results are in line with previous studies revealing the presence of a small, but significant increase in the risk of cardiac malformations in women who started taking ADHD medications before pregnancy. The risk grew in the latter half of pregnancy, as many women are forced to stop taking their ADHD medications. Women who used ADHD medication in the first trimester of pregnancy were also more likely to have caesarean section, low Apgar score after delivery and a baby that required breathing assistance at birth. However the researchers of the study were not able to eliminate selection bias by restricting the study to women who did not have other medical issues that could be a contributing factor to these findings. The researchers hope that their research will help inform the clinical decisions of doctors who see pregnant women. The researchers suggest that while discussing the risks and benefits are crucial, the decision regarding whether or not to stop medication should be in light of the severity of each woman's ADHD symptoms and her needs. The authors also advise that while discontinuing the medications is an alternative, it is not a recommended practice because of the high rate of depression and other mental health issues in women who are pregnant or who are recently postpartum. Furthermore, research suggests that women who choose to stop taking their medications are more likely to have a difficult time adjusting to life without them following the baby's arrival. Nursing The responsibilities that come with being a new mother can be overwhelming. Women who suffer from ADHD who have to manage their symptoms while attending physician appointments and making preparations for the arrival of their child and getting used to new routines at home may face a lot of challenges. Many women opt to continue taking their ADHD medication during pregnancy. The risk to breastfeeding infant is minimal because the majority of stimulant medications passes through breast milk in low amounts. The rate of medication exposure will vary based on the dosage, frequency of administration and the time of the day. In addition, various drugs enter the infant's system via the gastrointestinal tract or through breast milk. The effect on the health of a newborn is not completely known. Because of the lack of research, some physicians may recommend stopping stimulant drugs during a woman's pregnancy. It is a difficult decision for the woman who must weigh the benefits of her medication against the potential risks to the foetus. Until more information is available, doctors should inquire with all pregnant patients about their experience with ADHD and if they are taking or planning to take medication during the perinatal time. Numerous studies have proven that women can continue to take their ADHD medication safely during pregnancy and while breast-feeding. This has led to an increasing number of patients choose to do so and after consulting with their doctor, they have found that the benefits of maintaining their current medication far outweigh any potential 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 prescriber 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 understand their symptoms and the root cause Learn about the available treatment options and strengthen existing coping strategies. This should include a multidisciplinary approach, which includes the GP doctors, obstetricians and psychiatrists. Pregnancy counseling should include discussion of a treatment plan for the mother as well as the child, and monitoring for signs of deterioration, and, if needed modifications to the medication regimen.