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ADHD Medication During Pregnancy and Breastfeeding Women suffering from ADHD have to make a difficult choice on whether to keep or stop taking ADHD medication during pregnancy and breastfeeding. There aren't many studies on how long-term exposure may affect the fetus. A study recently published in Molecular Psychiatry demonstrates that children exposed to ADHD medication during pregnancy do not develop neurological issues like 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 pregnant and take ADHD medication must consider the benefits of taking it against the potential risks for the fetus. Physicians don't have the necessary data to provide clear recommendations but they can provide information on risks and benefits that assist pregnant women in making informed decisions. A study published in Molecular Psychiatry concluded that women who took ADHD medication during early pregnancy were not at higher risk of fetal malformations or structural birth defects. Researchers used a large population-based case control study to compare the incidence of major structural defects in infants born to mothers who used stimulants during pregnancy. Clinical geneticists and pediatric cardiologists reviewed the cases to ensure correct case classification and to limit the possibility of bias. The study conducted by the researchers was not without limitations. Researchers were unable in the beginning to distinguish the effects triggered by the medication from the disorder. This limitation makes it difficult to determine whether the limited associations observed in the groups that were exposed result from medication use or the confounding effect of comorbidities. Researchers also did not look at long-term outcomes for the offspring. adhd medication for adults uk did show that infants whose mothers had taken ADHD medications during pregnancy were at a slightly higher risk of being admitted to the neonatal intensive care unit (NICU) than those who were born without any medication or had stopped their medications before or during pregnancy. This increase was caused by central nervous system disorders. The increased risk of admission was not influenced by the stimulant medication that was used during pregnancy. Women who took stimulant ADHD medication during pregnancy also had an increased risk of having a caesarean section or having a child with a low Apgar score (less than 7). These increases appear to be unrelated to the type of medication used during pregnancy. Researchers suggest that the small risks posed by the use of ADHD medications during early pregnancies could be offset by the more beneficial outcomes for both mother and baby of continuing treatment for the woman’s disorder. Doctors should discuss with their patients about this issue and, if possible, help 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 continue treatment or stop during pregnancy as more women are diagnosed with ADHD. The majority of these decisions are taken in the absence of clear and authoritative evidence in either case, which means that doctors must weigh what they know about their experiences, the experiences of other doctors, and what research suggests on the subject as well as their best judgment for each individual patient. In particular, the issue of potential risks for the baby can be tricky. The research that has been conducted on this topic is based on observation instead of controlled studies and a lot of the results are in conflict. In addition, most studies limit their analysis to live births, which can underestimate severe teratogenic effects that result in abortion or termination of the pregnancy. The study that is discussed in this journal club addresses these limitations by analyzing data on live and deceased births. The conclusion: While some studies have found an association between ADHD medications and the possibility of certain birth defects, others have found no such relationship, and most studies have a neutral or slightly negative effect. As a result, a careful risk/benefit assessment must be done in each situation. For many women with ADHD and ADD, the decision to stop medication is difficult if not impossible. 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 loneliness, and family conflict for these patients. Additionally, the loss of medication may affect the ability to perform job-related tasks and drive safely, which are important aspects of a normal life for many people with ADHD. She recommends women who are unsure about whether to continue or stop medication in light of their pregnancy should consider educating family members, friends and colleagues about the condition, its effects on daily functioning, and the benefits of keeping the current treatment regimen. It can also help a woman feel confident about her decision. It is important to remember that certain medications are able to pass through the placenta, so if a woman decides to discontinue her ADHD medication during pregnancy and breastfeeding, she should be aware that the effects of the drug can be transferred to the infant. Birth Defects Risk As the use of ADHD medication to treat the symptoms of attention deficit hyperactivity disorder (ADHD) grows, so do concerns about what impact the drugs might have on the fetuses. A study that was published in the journal Molecular Psychiatry adds to the body of knowledge about this subject. Utilizing two huge data sets researchers were able to examine more than 4.3 million pregnancies and see whether the use of stimulant medications increased the risk of birth defects. Researchers found that while the risk overall is low, first-trimester ADHD medication use was associated with slightly higher rates of certain heart defects, like ventriculoseptal defects. The researchers of the study found no association between early use of medication and other congenital anomalies, such as facial clefting or club foot. The results are in the same vein as previous studies which showed an insignificant, but small increase in cardiac malformations for women who started taking ADHD medication before the time of pregnancy. This risk increased during the latter half of pregnancy, when a lot of women stopped taking their medication. Women who took ADHD medication during the first trimester were more likely require a caesarean birth or have an insufficient Apgar after birth and have a baby who needed breathing assistance at birth. However the authors of the study were not able to eliminate bias due to selection by restricting the study to women who didn't have other medical issues that could be a contributing factor to these findings. The researchers hope their study will serve to inform the clinical decisions of physicians who see pregnant women. The researchers suggest that while discussing benefits and risks are important, the choice on whether to continue or stop medication should be made based on the severity of each woman's ADHD symptoms and her requirements. The authors also warn that, while stopping the medication is an alternative, it is not an option to consider due to the high prevalence of depression and other mental health problems among women who are pregnant or post-partum. Research has also shown that women who stop taking their medications will have a difficult adjustment to life without them after the baby is born. Nursing The responsibilities of a new mother can be overwhelming. Women who suffer from ADHD who have to manage their symptoms while attending doctor appointments, getting ready for the arrival of their child and getting used to new routines at home are often faced with a number of difficulties. Many women choose to continue taking their ADHD medication during pregnancy. The majority of stimulant medications pass through breast milk in low amounts, so the risk to infant who is breastfeeding is low. However, the rate of medication exposure to the newborn can vary depending on dosage, how often it is taken and the time of the day it is administered. Additionally, individual medications enter the body of the baby differently through the gastrointestinal tract as well as breast milk, and the effect of this on a newborn is not fully understood. Some physicians may discontinue stimulant medication during a woman’s pregnancy due to the absence of research. It is a difficult decision for the woman who must weigh the advantages of continuing her medication against the potential risks to the foetus. In the meantime, until more information is available, doctors should ask all pregnant patients about their history of ADHD and whether they are taking or planning to take medication during the perinatal period. A growing number of studies have shown that most women can safely continue their ADHD medication during pregnancy and breastfeeding. In the end, many patients opt to do this, and in consultation with their doctor they have found that the benefits of maintaining their current medication outweigh any potential risks. It is crucial for women suffering from ADHD who are thinking of breastfeeding to seek a specialist psychiatrist's advice prior to becoming pregnant. They should discuss the medication they are taking with their physician, and the pros and cons of continuing treatment. This includes non-pharmacological strategies. Psychoeducation is also required to help pregnant women suffering from ADHD recognize the signs and the underlying disorder. They should also be informed about treatment options and strengthen strategies for coping. This should be a multidisciplinary process with the GPs, obstetricians and psychiatry. Counselling for pregnancy should include discussion of a management plan for both the mother as well as the child, monitoring for signs of deterioration and the need for adjustments to the medication regimen.