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ADHD Medication During Pregnancy and Breastfeeding Women suffering from ADHD face a difficult decision on whether to keep or stop taking ADHD medication during pregnancy and breast-feeding. There are few data on how long-term exposure may affect a fetus. A study recently published in Molecular Psychiatry shows that children exposed to ADHD medication in the uterus do not develop neurological developmental conditions like hearing or vision impairment seizures, febrile seizures or IQ impairment. The authors acknowledge that further 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 risks for the baby. Physicians do not have the data needed to give clear guidelines however they can provide information regarding the risks and benefits to help pregnant women make informed choices. A study published in Molecular Psychiatry found that women who took ADHD medications during early pregnancy did not face an increased risk of fetal heart malformations or major birth defects that are structural. Researchers conducted a large population-based case-control study to determine the prevalence of major structural birth defects in babies born to mothers who had taken stimulants in early pregnancy and those who had not. Pediatric cardiologists and clinical geneticists reviewed the cases to ensure an accurate case classification and to limit the chance of bias. The study of the researchers had some limitations. In particular, they were unable to distinguish the effects of the medication from the effects of the disorder that is underlying. This limitation makes it difficult for researchers to determine if the small associations observed among the groups exposed were due to the use of medications, or if they were confounded by co-morbidities. The researchers also did not study long-term outcomes for the offspring. The study revealed that babies whose mothers had taken ADHD medication during pregnancy were at a slightly higher chance of being admitted to the neonatal care unit (NICU) in comparison to those whose mothers did not take any medication during pregnancy, or had stopped taking their medication before or during pregnancy. This increase was caused by central nervous system disorders. The higher risk of admission was not affected by the stimulant medication used during pregnancy. Women who were taking stimulant ADHD medications during pregnancy also had a higher likelihood of having caesarean sections or a baby that scored low on the Apgar scale (less than 7). These increases appear to be unrelated to the type of medication taken during pregnancy. Researchers suggest that the small risks posed by the use of ADHD medications in early pregnancies may be offset by the greater benefits to both baby and mother of continued treatment for the woman's condition. Physicians should talk to their patients about this issue and, if possible, help them improve coping skills which may reduce the impact of her disorder in her daily functioning and her relationships. Medication Interactions Doctors are increasingly confronted with the dilemma of whether to continue treatment or stop as more women are diagnosed with ADHD. Most of the time, these decisions are taken in the absence of any evidence that is clear and definitive regardless, so doctors must weigh their knowledge about their experiences, the experiences of other doctors, and what research suggests on the subject as well as their own judgments for each patient. The issue of potential risks to infants is particularly tricky. Many of the studies on this issue are based on observational data instead of controlled research and their conclusions are often contradictory. The majority of studies limit their analysis to live-births, which could underestimate the severity of teratogenic effects that can lead to terminations or abortions of pregnancy. The study discussed in this journal club addresses these shortcomings by looking at data from both live and deceased births. Conclusion A few studies have revealed a positive correlation between ADHD medications and certain birth defects, other studies have not established a link. The majority of studies show that there is a neutral, or somewhat negative, impact. In each case it is imperative to conduct a thorough evaluation of the risks and benefits is required. For women suffering from ADHD, the decision to stop taking medication is difficult if not impossible. In a recent article published in the Archives of Women's Mental Health by psychologist Jennifer Russell, she notes that stopping ADHD medications during pregnancy can lead to depression and feelings of isolation. In addition, a decrease in medication can interfere with the ability to perform job-related tasks and drive safely, which are important aspects of a normal life for many people suffering from ADHD. She suggests that women who are unsure whether to take the medication or discontinue it due to pregnancy educate family members, coworkers, and their friends about the condition, its effects on daily functioning, and the advantages of staying on the current treatment. It will also help a woman feel confident about her decision. It is important to remember that some medications are able to pass through the placenta, so if a woman decides to discontinue her ADHD medication during pregnancy and breastfeeding, she must be aware that traces of the drug can be passed on to the baby. Risk of Birth Defects As the use and misuse of ADHD drugs to treat symptoms of attention deficit disorder hyperactivity disorder (ADHD), increases the concern over the potential adverse effects of the drugs on foetuses. A recent study published in the journal Molecular Psychiatry adds to the body of knowledge about this subject. Researchers utilized two massive datasets to analyze more than 4.3 million pregnancies and determine if the use of stimulant medications caused birth defects. Researchers discovered that although the overall risk is low, first-trimester ADHD exposure to medication was associated with slightly higher risk of specific heart defects like ventriculoseptal defects. The researchers of the study didn't find any association between the use of early medications and congenital anomalies like facial deformities or club feet. The results are in agreement with previous studies which showed the existence of a slight, but significant increase in cardiac malformations for women who began taking ADHD medication prior to the time of the time of pregnancy. The risk increased in the latter stages of pregnancy when a large number of women decided to stop taking their medication. Women who used ADHD medications during the first trimester of their pregnancy were also more likely to experience caesarean sections, a low Apgar score following delivery, and a baby who required breathing assistance at birth. However the researchers of the study were unable to eliminate selection bias by restricting the study to women who didn't have other medical issues that could have contributed to the findings. The researchers hope their study will serve to inform the clinical decisions of doctors who see pregnant women. They suggest that although discussing the risks and benefits is crucial but the decision to stop or continue treatment must be based on each woman's needs and the severity of her ADHD symptoms. The authors caution that, while stopping the medication is an option to think about, it isn't advised due to the high prevalence of depression and other mental disorders in women who are expecting or who have recently given birth. Further, the research suggests that women who choose to stop taking their medications are more likely to have a difficult time adjusting to life without them after the baby's arrival. Nursing The responsibilities that come with being a new mother can be overwhelming. Women who suffer from ADHD can face severe challenges when they must deal with their symptoms, go to doctor appointments, prepare for the birth of a baby and adjust to a new routine. medication for adult adhd is why many women elect to continue taking their ADHD medications throughout pregnancy. The majority of stimulant medications are absorbed by breast milk in very small amounts, therefore the risk to the infant who is breastfeeding is low. The amount of exposure to medications can vary depending upon the dosage the medication is administered, its frequency and the time of day. In addition, various medications enter the baby’s system through the gastrointestinal tract or through breast milk. The effect on the health of a newborn isn't fully comprehended. Because of the lack of research, some physicians might be tempted to stop taking stimulant drugs during a woman's pregnancy. This is a difficult decision for the patient, who must weigh the benefit of continuing her medication against the possible risks to the foetus. Until more information is available, doctors should ask all pregnant patients about their experience with ADHD and whether they are planning or taking to take medication during the perinatal period. Numerous studies have proven that women can continue taking their ADHD medication safely while breastfeeding and during pregnancy. As a result, more and more patients choose to do so and after consulting with their doctor, they have discovered that the benefits of maintaining their current medication far exceed any risk. Women who suffer from ADHD who are planning to nurse should seek advice from a specialist psychiatrist before becoming pregnant. They should discuss their medication with their doctor and discuss the pros and cons of continuing treatment. This includes non-pharmacological strategies. Psychoeducation is also necessary to help pregnant women with ADHD recognize the signs and underlying disorder. They should also be educated about treatment options and reinforce coping mechanisms. This should be a multidisciplinary process together with obstetricians, GPs and psychiatrists. Pregnancy counseling should include a discussion of a treatment plan for the mother as well as the child, and monitoring for signs of deterioration, and, if necessary, adjustments to the medication regime.