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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 breast-feeding. There isn't much information on how long-term exposure to these medications can affect the foetus. A study recently published in Molecular Psychiatry demonstrates that children exposed to ADHD medication during pregnancy do not develop neurological problems such as hearing loss or vision, febrile seizures or IQ impairment. The authors acknowledge the need for more high-quality research. Risk/Benefit Analysis Women who are pregnant and taking ADHD medications must weigh the benefits of taking them against potential risks to the foetus. Physicians don't have the necessary data to provide clear recommendations however they can provide information regarding benefits and risks that can 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 sample-based case control study to assess the frequency of major structural defects in infants born to mothers who took stimulants during pregnancy. Clinical geneticists, pediatric cardiologists and other experts reviewed the cases in order to make sure that the classification was correct and to eliminate any bias. The research conducted by the researchers had some limitations. The most important issue was that they were not able to differentiate the effects of the medication from those of the disorder at hand. add adhd medication makes it difficult for researchers to determine whether the few associations observed between the groups exposed were due to the use of medication or if they were confounded by the presence of comorbidities. In addition the researchers did not study the long-term outcomes of offspring. The study did find that infants whose mothers took ADHD medication during pregnancy were at a slightly greater risk of being admitted to the neonatal intensive care unit (NICU) than those who whose mothers did not take any medication or had taken off their medication prior to or during pregnancy. This increase was due to central nervous system-related disorders, and the increased risk of admission did not appear to be affected by the type of stimulant medications were taken during pregnancy. Women who took stimulant ADHD medication during pregnancy also had an elevated chance of having a caesarean section or having a child with an low Apgar score (less than 7). These increases did not seem to be influenced by the kind of medication used during pregnancy. The researchers suggest that the low risk associated with the use of ADHD medications during early pregnancy may be offset by the greater benefit to both the mother and child from continued treatment for the woman's condition. Physicians should discuss this with their patients and, where they are able, assist them in developing strategies to improve coping skills that can lessen the impact of her disorder on her daily functioning and relationships. Medication Interactions Doctors are increasingly faced with the decision of whether to continue treatment or stop during pregnancy as more women are diagnosed with ADHD. Often, these decisions are taken in the absence of any evidence that is clear and definitive either way, so physicians must weigh what they know about their experiences, the experiences of other doctors, and what research suggests about the subject, along with their own judgments for each patient. Particularly, the subject of possible risks to the baby can be a challenge. The research that has been conducted on this topic is based on observations rather than controlled studies, and many of the findings are conflicting. Additionally, the majority of studies limit their analysis to live births, which can underestimate the severity of teratogenic effects that could lead to abortion or termination of the pregnancy. The study discussed in the journal club addresses these limitations by analyzing both data on live and deceased births. The conclusion The conclusion: While some studies have shown that there is a positive correlation between ADHD medications and the possibility of certain birth defects, other studies have found no such relationship, and most studies demonstrate a neutral or slightly negative impact. Therefore, a careful risk/benefit analysis is required in every case. For many women with ADHD and ADD, the decision to stop taking medication can be difficult, if not impossible. In an article recently published in Archives of Women's Mental Health, psychologist Jennifer Russell notes that stopping ADHD medication during pregnancy can lead to increased depression, feelings of loneliness, and family conflict for those suffering from the disorder. Furthermore, a loss of medication may affect the ability to complete work-related tasks and safely drive that are crucial aspects of a normal life for a lot of people with ADHD. She suggests that women who aren't sure whether to continue taking the medication or discontinue it due to pregnancy should educate family members, coworkers and acquaintances about the condition, its effects on daily functioning, and the benefits of continuing the current treatment regimen. In addition, educating them can make the woman feel more comfortable in her struggle with her decision. It is important to remember that certain medications are able to pass through the placenta so if the patient decides to discontinue her ADHD medication during pregnancy and breastfeeding, she must be aware that traces of the medication could be transferred to the infant. Birth Defects Risk As the use and misuse of ADHD drugs to treat symptoms of attention deficit hyperactivity disorder (ADHD) increases as does the concern about the potential adverse effects of the drugs on fetuses. Recent research published in the journal Molecular Psychiatry has added to the body of knowledge regarding this subject. With two massive data sets researchers were able to look at more than 4.3 million pregnancies and see whether the use of stimulant medications increased the risk of birth defects. Although the risk overall is low, the researchers discovered that the first-trimester exposure to ADHD medications was associated with a slightly higher rate of specific heart defects, like ventriculo-septal defects (VSD). The researchers behind the study found no connection between early medication use and other congenital abnormalities, like facial clefting, or club foot. The results are in line with previous studies that showed an insignificant, but small increase in cardiac malformations for women who began taking ADHD medication prior to the birth of their child. This risk increased during the latter part of pregnancy when many women began to stop taking their medication. Women who used ADHD medications in the first trimester of their pregnancies were also more likely to have caesarean section, low Apgar score after delivery and a baby who needed breathing assistance at birth. The researchers of the study were not able to eliminate bias due to selection because they restricted the study to women without other medical conditions that might have contributed to the findings. The researchers hope their study will aid in the clinical decisions of physicians who see pregnant women. They advise that while the discussion of the benefits and risks is important however, the decision to stop or maintain treatment should be based on each woman's needs and the severity of her ADHD symptoms. The authors warn that, although stopping the medication is a possibility to think about, it isn't recommended due to the high rate depression and other mental problems in women who are expecting or recently gave birth. Further, research shows that women who stop taking their medication will have a difficult adjustment to life without them after the baby is born. Nursing The responsibilities of being a new mother can be overwhelming. Women with ADHD who must work through their symptoms while attending physician appointments, making preparations for the arrival of their child and getting used to new routines at home can experience severe challenges. Many women opt to continue taking their ADHD medication during pregnancy. The risk to breastfeeding infant is not too high since the majority of stimulant medications is absorbed through breast milk in low amounts. However, the amount of exposure to medication by the newborn can vary depending on dosage, frequency it is taken and the time of the day it is administered. In addition, individual medications enter the baby's system differently through the gastrointestinal tract as well as breast milk. The impact of this on a newborn is not fully understood. Some doctors may stop taking 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 continuing her medication against the risk to the foetus. In the meantime, until more information is available, doctors should inquire with all pregnant patients about their history of 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 during pregnancy and breast-feeding. As a result, many patients opt to do this and, in consultation with their doctor they have found that the benefits of keeping their current medication outweigh any risks. It's important for women with ADHD who are considering breastfeeding to seek out a specialist psychiatrist's advice prior to becoming pregnant. They should review their medications with their doctor and discuss the advantages and disadvantages of continued treatment, including non-pharmacological strategies. Psychoeducation should also be offered to help pregnant people with ADHD recognize their symptoms and the underlying disorder Learn about the available treatment options and strengthen existing strategies for managing. This should involve an approach that is multidisciplinary, including the GP doctors, obstetricians and psychiatrists. Pregnancy counselling should include discussion of a management plan for both the mother and child, monitoring for signs of deterioration and, if necessary, adjustments to the medication regimen.