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ADHD Medication During Pregnancy and Breastfeeding Women suffering from ADHD must make a difficult decision regarding whether or not to stop taking ADHD medication during pregnancy and breast-feeding. There aren't enough data regarding how exposure over time may affect the foetus. A recent study published in Molecular Psychiatry shows that children exposed to ADHD medication in the uterus do not develop neurological developmental disorders such as hearing or vision impairment seizures, febrile seizures or IQ impairment. The authors acknowledge the need for more high-quality studies. Risk/Benefit Analysis Women who are pregnant and taking ADHD medication must consider the benefits of taking it against the possible risks to the baby. Doctors don't have enough data to make unambiguous recommendations, but can provide information on the risks and benefits to assist pregnant women to make informed choices. A study published in Molecular Psychiatry found that women who used ADHD medications during their early pregnancy did not have a significantly higher risk of fetal cardiac malformations or major birth defects that are structural. Researchers conducted a large population-based case-control study to assess the risk of major structural birth defects in babies born to mothers who had taken stimulants in early pregnancy, as well as those who had not. Clinical geneticists, pediatric cardiologists and other experts examined the cases to ensure that the classification was accurate and to reduce any bias. The study of the researchers was not without limitations. In particular, they were not able to differentiate the effects of the medication from the underlying disorder. This makes it difficult for researchers to establish whether the few associations observed between the exposed groups were due to medication use or confounded by co-morbidities. Researchers also did not examine the long-term effects for the offspring. The study showed that infants whose mother took ADHD medication during pregnancy had a slightly greater risk of being admitted to the neonatal care unit (NICU), compared to mothers who did not use any medication during pregnancy or had quit taking the medication prior to or during pregnancy. This increase was due to central nervous system disorders, and the increased risk for admission did not appear to be affected by the type of stimulant medication was used during pregnancy. Women who were taking stimulant ADHD medication during pregnancy were also at an increased chance of having a caesarean delivery or having a baby with an low Apgar score (less than 7). These increases did not appear to be affected by the kind of medication used during pregnancy. The researchers suggest that the risk of a small amount with the use of ADHD medications during early pregnancy may be offset by the greater benefit 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 can lessen the negative impact of her condition on her daily life and relationships. Medication Interactions Doctors are increasingly confronted with the dilemma of whether to maintain treatment or stop during pregnancy as more women are diagnosed with ADHD. The majority of these decisions are made without any evidence that is clear and definitive regardless, so doctors must weigh their knowledge from their own experiences, those of other doctors, and what the research suggests about the subject and their best judgment for each individual patient. Particularly, the issue of possible risks to the baby can be tricky. A lot of studies on this issue are based on observational data rather than controlled research and their conclusions are often contradictory. medication for add adults of studies restrict their analysis to live births, which may underestimate the teratogenic impact that can lead to abortions or terminations of pregnancy. The study presented in the journal club addresses these shortcomings by analyzing both 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, other studies have found no such relationship and the majority of studies have a neutral or slightly negative effect. In all cases, a careful evaluation of the potential risks and benefits must be performed. For many women with ADHD, the decision to stop medication is difficult if not impossible. In fact, in an article published in Archives of Women's Mental Health, psychologist Jennifer Russell notes that stopping ADHD medication during pregnancy can cause depression, feelings of loneliness, and family conflict for patients with ADHD. A loss of medication may also impact the ability to drive safely and complete work-related tasks, which are vital aspects of daily life for those with ADHD. She suggests that women who are not sure whether to take the medication or stop due to pregnancy, educate their family members, coworkers, and acquaintances about the condition, the effects on daily functioning, and the benefits of keeping the current treatment. It will also help a woman feel more confident in her decision. It is important to note that some medications can pass through the placenta, so if the patient decides to discontinue her ADHD medication during pregnancy and breastfeeding, she must be aware of the possibility that traces of the medication could be transferred to the child. Risk of Birth Defects As the use and misuse of ADHD drugs to treat symptoms of attention deficit hyperactivity disorder (ADHD) increases the concern over the potential adverse effects of the drugs on foetuses. A study that was published in the journal Molecular Psychiatry adds to the existing knowledge about this subject. Researchers used two huge data sets to examine over 4.3 million pregnancies and determine if the use of stimulant medications increased the risk of birth defects. Researchers found that while the risk overall is low, the first trimester ADHD medication exposure was associated with slightly higher risk of specific heart defects such as ventriculoseptal defect. The researchers 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 line with previous studies which showed a small, but significant increase in cardiac malformations for women who began taking ADHD medication prior to pregnancy. The risk increased in 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, have a low Apgar after birth and have a baby that needed help breathing after birth. The authors of the study could not eliminate selection bias because they limited the study to women with no other medical conditions that could have contributed to the findings. The researchers hope their research will serve to inform the clinical decisions of doctors who see pregnant women. They suggest that although the discussion of the benefits and risks is important however, the decision to stop or keep treatment must be based on each woman's requirements and the severity of her ADHD symptoms. The authors warn that, while stopping the medication is an option to think about, it isn't advised because of the high incidence of depression and other mental disorders for women who are pregnant or who have recently given birth. Additionally, research suggests that women who stop taking their medication will have a difficult time adjusting to a life without them after the baby is born. Nursing It can be a challenge to become a mom. Women who suffer from ADHD who have to manage their symptoms while attending doctor appointments and getting ready for the arrival of their child and adjusting to new household routines are often faced with a number of difficulties. This is why many women elect to continue taking their ADHD medications throughout pregnancy. The majority of stimulant medicines pass through breast milk in very small amounts, so the risk to nursing infant is very low. However, the rate of medication exposure to the infant can differ based on the dosage, frequency it is administered, and the time of the day the medication is administered. Additionally, different medications enter the baby's system differently through the gastrointestinal tract and breast milk and the impact of this on a newborn isn't well understood. Some doctors may decide to stop 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 taking her medication as well as the risk to the foetus. In the meantime, until more information is available, doctors should inquire with all pregnant patients about their experience with ADHD and whether they plan or are taking to take medication during the perinatal time. A growing number of studies have shown that women can continue to take their ADHD medication while they are pregnant and nursing. In response, a rising number of patients are choosing to continue their medication. They have found through consultation with their physicians, that the benefits of continuing their current medication outweigh potential risks. It is essential for women with ADHD who are contemplating breastfeeding to seek out a specialist psychiatrist's guidance 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 is also needed to help pregnant women suffering from ADHD understand the symptoms and the underlying disorder. They should also learn about treatment options and reinforce the coping mechanisms. This should involve an approach that is multidisciplinary, including the GP doctors, obstetricians and psychiatrists. Pregnancy counselling should include the discussion of a plan for management for both the mother and child, and monitoring for signs of deterioration and the need for adjustments to the medication regimen.