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ADHD Medication During Pregnancy and Breastfeeding Women suffering from ADHD must make a difficult decision about whether to continue or stop taking ADHD medication during pregnancy and breast-feeding. There are few data on how exposure to ADHD for a long time could affect the pregnant fetus. A study recently published in Molecular Psychiatry demonstrates that children exposed to ADHD medication during pregnancy do not develop neurological problems like hearing loss or vision, febrile seizures or IQ impairment. The authors acknowledge the need for higher-quality studies. Risk/Benefit Analysis Women who are expecting and taking ADHD medication must evaluate the benefits of using it against the potential dangers for the foetus. Physicians don't have the data to make unambiguous recommendations, but can provide information on risks and benefits to assist pregnant women to make informed choices. A study published in Molecular Psychiatry found that women who used ADHD medications in early pregnancy did not have an higher risk of fetal cardiac malformations or major structural birth defects. Researchers conducted a massive population-based study of case control to assess the frequency of structural defects that were major in infants born to mothers who took stimulants during pregnancy. Clinical geneticists and pediatric cardiologists looked over the cases to ensure an accurate case classification and to limit the chance of bias. However, the study was not without its flaws. Most important, they were not able to differentiate the effects of the medication from those of the underlying disorder. That limitation makes it difficult to know whether the limited associations observed in the exposed groups result from medication use or comorbidities that cause confusion. In addition the study did not study the long-term outcomes of offspring. The study did find that infants whose mothers had taken ADHD medication during pregnancy were at slightly higher risk of being admitted to the neonatal intensive care unit (NICU) than those who were born without any medication or taken off their medication prior to or during pregnancy. The reason for this was central nervous system-related disorders and the increased risk for admission did not appear to be influenced by which 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 child with low Apgar score (less than 7). These risks did not appear to be influenced by the type of medication that was used during pregnancy. Researchers suggest that the minor risks posed by the use of ADHD medications during early pregnancies could be offset by the greater benefits to both mother and baby of continuing treatment for the woman's condition. Doctors should discuss with their patients about this and, if possible, help them improve coping skills which can lessen the impact of her disorder in her daily functioning and her relationships. Interactions with Medication Many doctors are confronted with the dilemma of whether to continue treatment or stop it during pregnancy 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 either way, so physicians 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 patient. The issue of potential risks to infants is particularly tricky. The research that has been conducted on this topic is based on observation rather than controlled studies and many of the findings are contradictory. The majority of studies focus on live-births, which could underestimate the teratogenic impact that can lead to terminations or abortions of pregnancy. The study discussed in this journal club addresses these limitations by analyzing data on live and deceased births. Conclusion A few studies have shown an association between ADHD medications and certain birth defects however, other studies haven't established a link. Most studies show a neutral, or even slightly negative, effect. Therefore, a careful risk/benefit assessment is required in every instance. It can be challenging, if not impossible for women suffering from ADHD to stop taking their medication. In an article 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 these patients. A decrease in medication could affect the ability to drive safely and to perform work-related tasks which are vital aspects of normal life for people with ADHD. She suggests that women who aren't sure whether to take the medication or stop it due to their pregnancy, educate their family members, coworkers and their friends about the condition, its effects on daily functioning, and the benefits of keeping the current treatment regimen. It can also help women feel more confident in her decision. It is important to note that certain drugs can pass through the placenta, so if the patient decides to stop taking her ADHD medication during pregnancy and breastfeeding, she must be aware that traces of the medication could be passed on to the baby. Risk of Birth Defects As the use of ADHD medications to treat symptoms of attention deficit hyperactivity disorder (ADHD) grows as do concerns over the impact that these medications could have on the fetuses. A study that was published in the journal Molecular Psychiatry adds to the body of information on this topic. Utilizing two huge data sets researchers were able analyze more than 4.3 million pregnancies and determine whether the use of stimulant medications increased the risk of birth defects. Researchers discovered that, while the overall risk is low, first-trimester ADHD exposure to medication was associated with slightly higher rates of certain heart defects, like ventriculoseptal defect. The authors of the study didn't discover any link between early medication usage and congenital anomalies like facial deformities, or club feet. The results are in line with previous studies revealing the presence of a small, but significant increase in the risk of heart malformations among women who began taking ADHD medications prior to pregnancy. This risk increased during the latter part of pregnancy, as many women decide to stop taking their ADHD medications. Women who took ADHD medication in the first trimester were more likely to need a caesarean or have a low Apgar after birth and had a baby that required breathing assistance when they were born. The researchers of the study were not able to eliminate selection bias because they restricted the study to women with no other medical conditions that might have contributed to the findings. Researchers hope their research will help doctors when they encounter pregnant women. The researchers recommend that, while discussing benefits and risks are important, the choice regarding whether or not to stop medication should be according to the severity of each woman's ADHD symptoms and her needs. The authors also advise that even though stopping the medication is an alternative, it is not an option to consider due to the high prevalence of depression and other mental health issues for women who are expecting or post-partum. Further, the research suggests that women who decide to stop taking their medications are more likely to experience 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 who must work through their symptoms while attending physician appointments as well as getting ready for the arrival of a baby and adjusting to new household routines are often faced with a number of difficulties. Many women choose to continue taking their ADHD medication during pregnancy. The majority of stimulant drugs are absorbed by breast milk in very small quantities, so the risk for breastfeeding infant is minimal. The amount of exposure to medications will vary based on the dosage, frequency of administration and the time of day. Additionally, individual medications enter the body of the baby differently through the gastrointestinal tract as well as breast milk. best adhd medication of this on a newborn isn't yet fully known. Because of the lack of research, some doctors may be inclined to discontinue stimulant medication during the course of pregnancy. This is a difficult decision for the patient, who must balance the benefit of continuing her medication against the possible risks to the foetus. In the meantime, until more information is available, doctors should ask all pregnant patients about their experience with ADHD and if they plan or are taking to take medication during the perinatal period. A growing number of studies have shown that the majority of women are able to safely continue to take their ADHD medication while they are pregnant and nursing. In response, a rising number of patients are opting to do this. They have found through consultation with their physicians that the benefits of continuing their current medication outweigh any possible risks. It is essential for women with ADHD who are considering breastfeeding to seek out a specialist psychiatrist's advice prior to becoming pregnant. They should discuss their medication with their doctor as well as the pros and cons for continuing treatment. This includes non-pharmacological strategies. Psychoeducation should also be provided to help pregnant people with ADHD recognize their symptoms and underlying disorder and learn about treatment options and reinforce existing coping strategies. This should involve a multidisciplinary approach with the GP as well as obstetricians, psychiatry and obstetricians. Pregnancy counseling should include discussion of a treatment plan for the mother and the child, and monitoring for signs of deterioration, and, if needed, adjustments to the medication regimen.