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ADHD Medication During Pregnancy and Breastfeeding Women suffering from ADHD must make a difficult decision on whether to keep or stop taking ADHD medication during pregnancy and breast-feeding. There isn't much information on how long-term exposure to these medications could affect the fetus. A study recently published in Molecular Psychiatry demonstrates that children exposed to ADHD medication during pregnancy do not develop neurological problems such as impaired hearing or vision, febrile seizures, or IQ impairment. The authors acknowledge the need for higher-quality studies. Risk/Benefit Analysis Women who are expecting and taking ADHD medication should evaluate the benefits of using it against the possible risks for the baby. The doctors don't have the information to make unambiguous recommendations however they can provide information about risks and benefits to aid pregnant women in making informed decisions. A study published in Molecular Psychiatry found that women who used ADHD medications during their early pregnancy did not face a significantly higher risk of fetal cardiac malformations or major birth defects that are structural. Researchers used a vast, population-based case-control study to determine the prevalence of major structural birth defects in babies born to mothers who had taken stimulants in the early stages of pregnancy, and those who did not. Pediatric cardiologists and clinical geneticists examined the cases to ensure correct case classification and to limit the possibility of bias. However, the researchers' study had its limitations. The most important issue was that they were not able to differentiate the effects of the medication from those of the disorder that is underlying. This limitation makes it difficult to determine whether the small associations observed in the groups that were exposed are due to the use of medication or confounding by comorbidities. In addition, the researchers did not examine the long-term effects of offspring on their parents. The study found that infants whose mothers took ADHD medication during pregnancy had a slightly greater risk of being admitted to the neonatal care unit (NICU) in comparison to those whose mothers did not take any medication during pregnancy or quit taking the medication prior to or during pregnancy. This was due to central nervous system-related disorders, and the increased risk of admission was not found to be affected by the type of stimulant medications were used during pregnancy. Women who were taking stimulant ADHD medications during pregnancy also had a higher risk of having to have a caesarean section or a baby that scored low on the Apgar scale (less than 7). These increases appeared to be independent of the type of medication used during pregnancy. The research suggests that the risk of a small amount with the use of ADHD medications during early pregnancy could be offset by the greater benefits for both mother and child of continuing treatment for the woman's condition. Physicians should talk to their patients about this issue and try to help them improve coping skills which may reduce the impact of her disorder in her daily functioning and her relationships. Medication Interactions More and more doctors are faced with the decision of whether to keep treatment or stop as more women are diagnosed with ADHD. These decisions are frequently made without clear and reliable evidence. Instead, doctors have to consider their own expertise in conjunction with the experiences of other doctors, and the research that has been conducted on the subject. The issue of possible risks for infants can be extremely difficult. A lot of studies on this subject are based on observational data instead of controlled research and their conclusions are often contradictory. Most studies limit their analysis to live births, which can underestimate the severity of teratogenic effects which can cause abortions or terminations of pregnancy. The study discussed in this journal club addresses these issues by looking at data from both live and deceased births. The conclusion The conclusion: While some studies have found an association between ADHD medications and the possibility of certain birth defects, other studies have found no connection, and most studies show a neutral or even slightly negative impact. Therefore, a careful risk/benefit analysis must be conducted in every situation. It isn't easy, but not impossible, for women suffering from ADHD to stop taking their medication. In fact, in an article recently published in Archives of Women's Mental Health psychologist Jennifer Russell notes that stopping ADHD medication during pregnancy can increase depression, feelings of isolation, and family conflict for these patients. The loss of medication can affect the ability to drive safely and perform work-related tasks, which are crucial aspects of everyday life for people with ADHD. She suggests women who are unsure about whether to keep or stop taking medication because of their pregnancy consider informing family members, friends, and coworkers on the condition, its impact on daily functioning, and on the benefits of keeping the current treatment plan. It can also help women feel more confident in her decision. Some medications can pass through the placenta. If the patient decides to not take her ADHD medication while breastfeeding, it's important to be aware that the medication could be passed on to her infant. Birth Defects and Risk of As the use and misuse of ADHD medications to treat the symptoms of attention deficit hyperactivity disorder (ADHD) is increasing, so does concern about the potential adverse effects of the drugs on foetuses. A study that was published in the journal Molecular Psychiatry adds to the existing knowledge about this subject. With two massive data sets researchers were able to look at more than 4.3 million pregnancies and see whether stimulant medication use increased the risk of birth defects. While the overall risk remains low, the scientists did find that first-trimester exposure to ADHD medications was linked to an increased risk of certain heart defects, like ventriculo-septal defects (VSD). The authors of the study found no association between early use of medication and other congenital abnormalities, such as facial clefting or club foot. The results are in line with previous studies that have shown a small, but significant increase in cardiac malformations for women who began taking ADHD medication prior to the time of the birth of their child. This risk increased during the latter part of pregnancy when a large number of women stopped taking their medication. Women who used ADHD medications in the first trimester of their pregnancies were also more likely to undergo caesarean section, low Apgar score following delivery, and a baby that required breathing assistance during birth. homepage of the study could not eliminate selection bias because they limited their study to women who did not have any other medical conditions that could have contributed to the findings. Researchers hope that their study will help doctors when they encounter pregnant women. The researchers advise that, while discussing benefits and risks are important, the choice regarding whether or not to stop medication should be based on the severity of each woman's ADHD symptoms and her requirements. The authors also warn that, while stopping the medication is an option, it is not a recommended practice because of the high prevalence of depression and other mental health issues in women who are pregnant or who are recently post-partum. Research has also shown that women who stop taking their medications will have a tough time adjusting to a life without them after the baby is born. Nursing It can be a stressful experience becoming a mother. Women suffering from 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 a child and adjust to a new routine. As such, many women decide to continue taking their ADHD medication throughout the pregnancy. The majority of stimulant medications pass through breast milk in small amounts, so the risk for breastfeeding infant is minimal. The rate of exposure to medication will vary based on the dosage and frequency of administration as well as time of day. In addition, individual medications enter the infant's system differently through the gastrointestinal tract and breast milk. The impact of this on a newborn is not yet fully known. Because of the lack of research, some doctors may recommend stopping stimulant drugs during the pregnancy of a woman. It's a difficult choice for the woman who must weigh the advantages of continuing her medication against the risk to the foetus. As long as there is no more information, GPs should ask all pregnant patients about their experience with ADHD and if they plan or are taking to take medication during the perinatal time. Many studies have shown that women can continue taking their ADHD medication without risk during pregnancy and while breast-feeding. In the end, more and more patients opt to do this and, after consulting with their doctor, they have found that the benefits of maintaining their current medication far exceed any risk. It's important for women with ADHD who are contemplating breastfeeding to seek a specialist psychiatrist's advice prior becoming pregnant. They should discuss their medication with their prescriber and discuss the pros and cons of continued treatment, including non-pharmacological management strategies. Psychoeducation should also be offered to help pregnant people with ADHD be aware of their symptoms and underlying disorder and learn about treatments and to reinforce existing strategies for coping. This should involve an approach that is multidisciplinary, including the GP doctors, obstetricians and psychiatrists. The pregnancy counselling should consist of the discussion of a treatment plan for both mother and child, and monitoring for signs of deterioration and the need for adjustments to the medication regimen.