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ADHD Medication During Pregnancy and Breastfeeding Women suffering from ADHD have to make a difficult choice about whether to continue or stop taking ADHD medication during pregnancy and breast-feeding. There is a lack of information about how long-term exposure to these drugs could affect the foetus. A study recently published in Molecular Psychiatry shows that children exposed to ADHD medication during the uterus don't develop neurological developmental conditions like hearing or vision impairment, febrile seizures, or IQ impairment. The authors acknowledge the need for more high-quality studies. Risk/Benefit Analysis Pregnant women who use ADHD medications need to balance the advantages of using them against the risks to the fetus. Physicians do not have the information needed to provide clear recommendations, but they can provide information about the risks and benefits to aid pregnant women in making informed choices. A study published in Molecular Psychiatry concluded that women who were taking ADHD medication in early pregnancy were not at greater risk of fetal malformations or structural birth defects. The researchers used a large population-based case-control study to determine the prevalence of major structural birth defects in babies born to mothers who took stimulants during early pregnancy and those who had not. Pediatric cardiologists and clinical geneticists reviewed the cases to ensure accurate classification of the cases and to reduce the chance of bias. However, the study was not without its flaws. The most important issue was that they were not able to differentiate the effects of the medication from the effects of the underlying disorder. This limitation makes it difficult to know whether the limited associations observed in the groups that were exposed result from medication use or confounding by comorbidities. Researchers also did not study the long-term effects for the offspring. The study showed 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 quit taking the medication prior to or during pregnancy. This increase was caused by central nervous system disorders. add adult medications increased risk of admission was not affected by the stimulant medications used during pregnancy. Women who were taking stimulant ADHD medications during pregnancy also had a higher likelihood of having a caesarean section or one whose baby scored low on the Apgar scale (less than 7). These increases did appear 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 the early stages of pregnancy could be offset by the greater benefit to both mother and child of continued treatment for the woman's disorder. Physicians should speak with their patients about this and as much as possible, assist them develop coping strategies that may reduce the impact of her disorder in her daily life and relationships. Medication Interactions Many doctors are confronted with the dilemma of whether to maintain treatment or stop as more women are diagnosed with ADHD. These decisions are frequently taken without clear and authoritative evidence. Instead, physicians must weigh their own knowledge and experience, as well as the experiences of other doctors and the research on the subject. Particularly, the issue of potential risks for the baby can be a challenge. Many studies on this topic are based on observations rather than controlled research and their conclusions are often contradictory. In addition, most studies limit their analysis to live births, which may underestimate severe teratogenic effects that result in abortion or termination of the pregnancy. The study that is discussed in the journal club addresses these issues, 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. Most studies show that there is a neutral, or slight negative effect. As a result, a careful risk/benefit analysis is required in every case. It isn't easy, but not impossible for women suffering from ADHD to stop taking their medication. In a recent article in Archives of Women's Mental Health, psychologist Jennifer Russell notes that stopping ADHD medication during pregnancy can lead to increased depression, feelings of isolation, and family conflict for patients with ADHD. Furthermore, a loss of medication can interfere with the ability to perform work-related tasks and safely drive, which are important aspects of daily life for a lot of people with ADHD. She recommends that women who are unsure about whether or not to discontinue medication due to their pregnancy should consider informing family members, friends and colleagues on the condition, its effects on daily functioning, and on the benefits of keeping the current treatment regimen. It can also help the woman feel supported as she struggles with her decision. It is also worth noting that some medications can pass through the placenta therefore, if a patient decides to stop her ADHD medication during pregnancy and breastfeeding, she should be aware that the effects of the drug can be transferred to the infant. Risk of Birth Defects As the use of ADHD medication to treat the symptoms of attention deficit hyperactivity disorder (ADHD) increases there are concerns about the effects that the medications could have on the fetuses. A study that was published in the journal Molecular Psychiatry adds to the existing knowledge on this subject. Researchers used two massive datasets to analyze over 4.3 million pregnancy and determine if the use of stimulant medications increased birth defects. Researchers discovered that although the risk overall is low, the first trimester ADHD medication exposure was associated with slightly higher rates of specific heart defects like ventriculoseptal defects. The authors of the study found no association between early use of medication and other congenital anomalies, like facial clefting, or club foot. The results are in agreement with previous studies that showed the existence of a slight, but significant increase in cardiac malformations for women who started taking ADHD medication prior to pregnancy. This risk increased during the latter part of pregnancy, as many women decide to stop taking their ADHD medication. Women who used ADHD medications in the first trimester of their pregnancy were also more likely to experience caesarean sections, a low Apgar score following delivery, and a baby that required breathing assistance at birth. However, the authors of the study were unable to eliminate selection bias by limiting the study to women who didn't have other medical issues that could have contributed to these findings. Researchers hope their research will provide doctors with information when they meet pregnant women. They advise that while discussing the benefits and risks is important, the decision to stop or keep treatment should 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 is not a recommended practice because of the high rate of depression and other mental health issues among women who are pregnant or who are recently postpartum. Further, research shows that women who stop taking their medications will have a difficult transitioning to life without them after the baby is born. Nursing It can be a challenge to become a mother. Women with ADHD who must work through their symptoms while attending doctor appointments, preparing for the arrival of a child and adapting to new routines in the home are often faced with a number of difficulties. Many women decide to continue taking their ADHD medication during pregnancy. The majority of stimulant medicines pass through breast milk in very small amounts, so the risk to nursing infant is very low. The amount of exposure to medications can vary depending upon the dosage and frequency of administration as well as the time of day. In addition, different drugs enter the infant's system through the gastrointestinal tract or through breast milk. The impact on the health of a newborn is not fully understood. Some physicians may discontinue stimulant medication during a woman’s pregnancy due to the lack of research. This is a difficult decision for the patient, who must balance the benefit of continuing her medication with the potential dangers to the foetus. Until more information becomes available, doctors can ask pregnant patients if they have an background of ADHD or if they are planning to take medication during the perinatal phase. A increasing number of studies have proven that most women can safely continue to take their ADHD medication during pregnancy and breastfeeding. This has led to many patients opt to do this and after consulting with their doctor, they have found that the benefits of continuing their current medication exceed any risk. Women with ADHD who are planning to breastfeed should seek advice from an expert psychiatrist prior to becoming pregnant. They should discuss their medication with their prescriber, and the pros and cons of continuing treatment. This includes non-pharmacological strategies. Psychoeducation should also be provided to help pregnant women suffering from ADHD recognize their symptoms and the underlying disorder Learn about the available treatment options and strengthen existing strategies for coping. This should be a multidisciplinary approach together with obstetricians, GPs and psychiatrists. Pregnancy counselling should include discussion of a management plan for both mother and child, monitoring for signs of deterioration, and the need for adjustments to the medication regimen.