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ADHD Medication During Pregnancy and Breastfeeding The choice of whether to stop or continue ADHD medication during pregnancy and nursing is challenging for women with the condition. There are few data on how long-term exposure may affect the pregnant fetus. A recent study 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 that more high-quality research is needed. Risk/Benefit Analysis Women who are expecting and taking ADHD medication should evaluate the benefits of using it against the possible dangers for the baby. The doctors don't have the information to give clear advice but they can provide information on risks and benefits to help pregnant women make an informed decision. A study published in Molecular Psychiatry concluded that women who were taking ADHD medication during their early pregnancy were not at a greater risk of fetal malformations, or structural birth defects. Researchers used a large population-based case control study to assess the frequency of major structural defects in infants who were born to mothers who took stimulants during pregnancy. Clinical geneticists and pediatric cardiologists looked over the cases to ensure accurate classification of the cases and to reduce the chance of bias. However, the researchers' study was not without its flaws. In particular, they were unable to distinguish the effects of the medication from those of the underlying disorder. This limitation makes it difficult to determine whether the small differences observed in the exposed groups are due to the use of medication or the confounding effect of comorbidities. The researchers also did not look at the long-term effects for the offspring. The study found 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 quit taking the medication prior to or during pregnancy. This was due to central nervous system disorders. The increased risk of admission was not influenced by the stimulant medications used during pregnancy. Women who took stimulant ADHD medications during pregnancy also had a higher chance of having a caesarean section or 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 research suggests that the low risk associated with the use of ADHD medications during the early stages of pregnancy could be offset by the greater benefits to both mother and child from continued treatment for the woman's condition. Physicians should discuss the issue with their patients and, if possible, assist them in developing strategies for improving their coping skills that may minimize the effects of her disorder on her daily functioning and relationships. Interactions with Medication As more women than ever are being diagnosed with ADHD and treated with medication, the question of whether to keep or stop treatment during pregnancy is a question that more and more doctors confront. These decisions are frequently made 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. In particular, the issue of possible risks to the baby can be a challenge. A lot of studies on this subject are based on observations rather than controlled research and their conclusions are often contradictory. The majority of studies limit their analysis to live births, which can underestimate the severity of teratogenic effects that can lead to terminations or abortions of pregnancy. The study presented in the journal club addresses these shortcomings, by examining both information on deceased and live births. Conclusion: While some studies have shown a positive correlation 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, a careful risk/benefit assessment is required in every case. It isn't easy, but not impossible for women with ADHD to stop taking their medication. In a recent article in the Archives of Women's Mental Health, psychologist Jennifer Russell notes that stopping ADHD medication during pregnancy can increase depression, feelings of loneliness, and family conflict for patients with ADHD. Furthermore, a loss of medication can interfere with the ability to complete jobs and drive safely, which are important aspects of daily life for many people suffering from ADHD. She suggests women who are uncertain about whether or not to discontinue medication due to their pregnancy consider the possibility of educating friends, family members and colleagues on the condition, its effects on daily functioning, and the advantages of continuing the current treatment regimen. Educating them can also make the woman feel more comfortable when she is struggling with her decision. Some medications can pass through the placenta. If a woman decides to stop taking her ADHD medication while pregnant and breastfeeding, it's important to be aware that the drug may be transferred to her baby. Birth Defects and Risk of As the use and misuse of ADHD medications to treat the symptoms of attention deficit disorder hyperactivity disorder (ADHD) is increasing as does the concern about the potential adverse effects of the drugs on fetuses. A study that was published in the journal Molecular Psychiatry adds to the existing information on this topic. Using two massive data sets researchers were able examine more than 4.3 million pregnancies to determine whether stimulant medication use increased the risk of birth defects. Researchers discovered that although the risk overall is low, first-trimester ADHD medication exposure was associated with slightly higher rates of certain heart defects, like ventriculoseptal defect. The researchers of the study found no link between early use of medication and congenital abnormalities such as facial clefting or club foot. The results are in agreement with previous studies which showed an insignificant, but small increase in the number of cardiac malformations among women who started taking ADHD medication before the time of pregnancy. This risk increased in the later part of pregnancy, when a lot of women are forced to stop taking their ADHD medications. Women who used ADHD medications in the first trimester of pregnancy were also more likely to experience caesarean sections, a low Apgar score after delivery and a baby who needed breathing assistance during birth. medication for adult add of the study were not able to eliminate selection bias because they limited their study to women without other medical conditions that might have contributed to the findings. Researchers hope that their research will help doctors when they meet pregnant women. They suggest that although the discussion of risks and benefits is important, the decision to stop or keep medication must be based on each woman's needs and the severity of her ADHD symptoms. The authors also caution that, while stopping the medication is an option, it isn't an option that is recommended due to the high prevalence of depression and other mental health problems among women who are pregnant or recently post-partum. Additionally, research suggests that women who stop taking their medications will have a difficult time adjusting to a life without them once the baby is born. Nursing The responsibilities that come with being a new mother can be overwhelming. Women with ADHD who have to manage their symptoms while attending physician appointments and preparing for the arrival of a child and adapting to new routines in the home may face a lot of challenges. Many women decide to continue taking their ADHD medication during pregnancy. The risk for breastfeeding infant is minimal because the majority of stimulant medication passes through breast milk in low amounts. However, the rate of medication exposure to the infant can differ based on the dosage, frequency it is taken and the time of day the medication is administered. Additionally, different medications enter the baby's system differently through the gastrointestinal tract as well as breast milk, and the effect of this on a newborn isn't fully known. Some doctors may decide to stop stimulant medication during a woman’s pregnancy due to the absence of research. It's a difficult choice for the woman, who must weigh the advantages of taking her medication as well as the potential risks to the fetus. Until more information is available, doctors should ask all pregnant patients about their experience with ADHD and if they are planning or taking to take medication during the perinatal time. Numerous studies have demonstrated that women can continue to take their ADHD medication in a safe manner during pregnancy and while breast-feeding. In response, a growing number of patients are opting to do this. They have discovered through consultation with their physicians that the benefits of keeping their current medication outweigh any possible risks. Women who suffer from ADHD who are planning to breastfeed should seek advice from 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 is also necessary to help pregnant women suffering from ADHD be aware of the symptoms and underlying disorder. They should also learn about treatment options and strengthen the coping mechanisms. This should be a multidisciplinary process with the GPs, 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 necessary modifications to the medication regime.