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ADHD Medication During Pregnancy and Breastfeeding The choice of whether to stop or continue ADHD medications during pregnancy and nursing is a difficult decision for women suffering from the condition. Little data exists about how long-term exposure to these medications can affect the fetus. A recent study published in Molecular Psychiatry shows that children exposed to ADHD medication during the uterus don't develop neurological disorders like impaired vision or hearing seizures, febrile seizures or IQ impairment. The authors acknowledge that further high-quality studies are required. Risk/Benefit Analysis Women who are pregnant and take ADHD medication need to evaluate the benefits of using it versus the risks to the baby. Physicians don't have the information needed to give clear guidelines however they can provide information on benefits and risks that can assist pregnant women in making informed decisions. A study published in Molecular Psychiatry found that women who took ADHD medications in early pregnancy did not face an increased risk of fetal heart malformations or major birth defects that are structural. Researchers used a large population-based study of case control to assess the frequency of structural defects that were major in infants born to mothers who took stimulants during pregnancy. Clinical geneticists, pediatric cardiologists and other experts examined the cases to ensure that the classification was accurate and to eliminate any bias. The study of the researchers was not without its limitations. Researchers were unable, in the first place to differentiate the effects triggered by the medication from the disorder. This limitation makes it difficult to determine whether the small differences observed in the groups that were exposed are due to medication use or the confounding effect of comorbidities. In addition the researchers did not study the long-term outcomes of offspring. The study showed that infants whose mothers had taken ADHD medication during pregnancy were at a slightly greater risk of being admitted to the neonatal care unit (NICU), compared to mothers who did not take any medication during pregnancy or quit taking the medication prior to or during pregnancy. The reason for this was central nervous system-related disorders, and the increased risk for admission was not found to be influenced by the stimulant medications were taken during pregnancy. Women who were taking stimulant ADHD medication during pregnancy were also at an elevated chance of having a caesarean delivery or having a baby with an low Apgar score (less than 7). These increases appear to be independent of the type of medication taken during pregnancy. The researchers suggest that the small risk associated with the use of ADHD medications during early pregnancy could be offset by the higher benefit to both mother and child of continuing treatment for the woman's disorder. Physicians should speak with their patients about this and, if possible, help them develop coping strategies that could reduce the impact of her disorder in her daily functioning and her relationships. Medication Interactions Many doctors are faced with the decision of whether to maintain treatment or stop it during pregnancy as more women are diagnosed with ADHD. The majority of these decisions are taken in the absence of clear and authoritative evidence either way, so physicians have to weigh their experience, the experiences of other doctors, and what research says on the topic and their own best judgment for each patient. Particularly, the subject of potential risks to the baby can be tricky. Many of the studies on this issue are based on observations rather than controlled research, and their conclusions are often contradictory. Most studies restrict their analysis to live births, which can underestimate the teratogenic impact leading to terminations or abortions of pregnancy. The study discussed in this journal club addresses these limitations by analyzing data on live and deceased births. Conclusion A few studies have revealed a positive correlation between ADHD medications and certain birth defects however, other studies haven't shown such a relationship. Most studies have shown that there is a neutral, or slight negative effect. In all cases, a careful evaluation of the risks and benefits should be conducted. It can be difficult, if not impossible, for women with 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 cause depression and feelings of isolation. A loss of medication may also affect the ability to safely drive and to perform work-related tasks which are crucial aspects of normal life for those suffering from ADHD. She suggests that women who are unsure about whether to keep or stop medication in light of their pregnancy consider informing family members, friends and colleagues on the condition, its effects on daily functioning, and the advantages of staying on the current treatment plan. In medications for adhd in adults , educating them can aid in ensuring that the woman feels supported when she is struggling with her decision. Certain 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 transferred to the infant. Birth Defects and Risk of As the use and misuse of ADHD medication to treat symptoms of attention deficit disorder hyperactivity disorder (ADHD) is increasing the concern over the potential adverse effects of the drugs on foetuses. Recent research published in the journal Molecular Psychiatry has added to the body of knowledge on this subject. Researchers used two massive data sets to examine more than 4.3 million pregnancies and determine whether stimulant medications increased the risk of birth defects. Although the risk overall remains low, the scientists found that exposure in the first trimester to ADHD medications was associated with an increase in the risk of certain heart defects, such as ventriculo-septal defect (VSD). The researchers of the study found no association between early medication use and congenital abnormalities like facial clefting, or club foot. The results are in line with previous studies that showed an insignificant, but small increase in the number of cardiac malformations among women who started taking ADHD medication prior to the time of the birth of their child. This risk increased in the latter half of pregnancy, as many women decide to stop taking their ADHD medication. Women who took ADHD medication in the first trimester were more likely require a caesarean birth and also have a low Apgar after birth and had a baby that required breathing assistance after birth. However the authors of the study were unable to eliminate selection bias by restricting the study to women who did not have any other medical conditions that could have contributed to these findings. The researchers hope that their research will help inform the clinical decisions of doctors who treat pregnant women. The researchers suggest that while discussing risks and benefits are important, the decision regarding whether or not to stop medication should be made based on the severity of each woman's ADHD symptoms and the needs of the woman. The authors caution that, although stopping the medication is a possibility to consider, it is not recommended due to the high prevalence of depression and other mental disorders among women who are pregnant or recently gave birth. Further, research shows that women who stop taking their medication will have a harder time adjusting to a life without them once the baby is born. Nursing It can be a stressful experience to become a mom. Women with ADHD who must work through their symptoms while attending doctor appointments as well as making preparations for the arrival of a baby and adjusting to new household routines can experience severe challenges. Many women decide to continue taking their ADHD medication during pregnancy. The risk to a breastfeeding infant is minimal because the majority of stimulant medication is absorbed through breast milk at a low level. However, the amount of exposure to medication by the infant can differ based on the dosage, frequency it is administered, and the time of the day it is administered. In addition, different medications are introduced into the baby's system through the gastrointestinal tract or through breast milk. The impact on the health of a newborn isn't fully understood. Due to the absence of evidence, some doctors may recommend stopping stimulant medications during the course of pregnancy. This is a difficult decision for the patient, who must balance the benefits of continuing her medication against the potential risks to the fetus. In the meantime, until more information is available, GPs should ask all pregnant patients about their history of ADHD and whether they are taking or planning to take medication during the perinatal period. Many studies have shown that women can continue taking their ADHD medication in a safe manner during pregnancy and breast-feeding. In the end, an increasing number of patients opt to do this, and in consultation with their physician, they have discovered that the benefits of maintaining their current medication far outweigh any risks. Women who suffer from ADHD who plan to breastfeed should seek advice from a specialist psychiatrist prior to becoming pregnant. They should review their medications with their doctor and discuss the advantages and disadvantages of continuing treatment, including non-pharmacological management strategies. Psychoeducation is also required to help pregnant women with ADHD recognize the signs and underlying disorder. They should also be informed about treatment options and strengthen strategies for coping. This should include a multidisciplinary approach with the GP, obstetricians and psychiatry. Counselling for pregnancy should include the discussion of a treatment plan for both the mother and child, as well as monitoring for signs of deterioration, and when necessary, making adjustments to the medication regimen.