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ADHD Medication During Pregnancy and Breastfeeding The choice of whether to stop or continue ADHD medications during breastfeeding and pregnancy is challenging for women with the condition. There is a lack of information about how long-term exposure to these drugs can affect the fetus. A study recently published in Molecular Psychiatry shows that children exposed to ADHD medication in utero do not develop neurological disorders such as hearing loss or impaired vision seizures, febrile seizures or IQ impairment. The authors acknowledge that more high quality studies are required. Risk/Benefit Analysis Women who are pregnant and taking ADHD medication must evaluate the benefits of using it against the potential risks for the fetus. Doctors don't have the necessary data to make unequivocal recommendations however they can provide information regarding the risks and benefits to help pregnant women make informed decisions. A study published in Molecular Psychiatry found that women who took ADHD medications during early pregnancy did not have an increased risk of fetal cardiac malformations or major birth defects that are structural. Researchers used a vast population-based study of case-control to evaluate the incidence of major structural birth defects in babies born to mothers who took stimulants during the early stages of pregnancy, as well as those who had not. Clinical geneticists and pediatric cardiologists examined the cases to ensure correct classification of the cases and to reduce the possibility of bias. However, the researchers' study had its limitations. Researchers were unable, in the first place to differentiate the effects caused by the medication from the disorder. This makes it difficult for researchers to determine whether the small associations observed among the groups that were exposed to medication use, or if they were caused by co-morbidities. Additionally the researchers did not study the long-term outcomes of offspring. The study revealed that babies whose mothers took ADHD medication during pregnancy were at a slightly greater risk of being admitted to the neonatal care unit (NICU) as compared to mothers who didn't take any medication during pregnancy, or had discontinued taking their medication prior to or during pregnancy. The reason for this was central nervous system-related disorders and the increased risk of admission was not found to be influenced by which stimulant medications were used during pregnancy. Women who took stimulant ADHD medications during pregnancy also had a higher chance of having a caesarean section or the baby was not scoring well on the Apgar scale (less than 7). These increases appear to be unrelated to the type of medication used during pregnancy. The researchers suggest that the small risk associated with the use of ADHD medications during the early stages of pregnancy may be offset by the higher benefit for both mother and child of continuing treatment for the woman's condition. Physicians should talk to their patients about this and as much as possible, assist them develop coping skills that could reduce the effects of her disorder on her daily functioning and her relationships. Medication Interactions Doctors are increasingly confronted with the dilemma of whether to keep treatment or stop 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, the experiences of other doctors, and what research says on the topic, along with their own judgments for each patient. The issue of potential risks to infants is particularly tricky. A lot of studies on this subject are based on observations rather than controlled research, and their conclusions are often contradictory. Furthermore, most studies restrict their analysis to live births, which can underestimate the severity of teratogenic effects that could result in abortion or termination of the pregnancy. The study that is discussed in the journal club addresses these limitations by analyzing the data from deceased and live births. The conclusion is that while some studies have found that there is a positive correlation between ADHD medications and the possibility of certain birth defects, others have not found any evidence of a link and the majority of studies show a neutral or even slightly negative effect. In each case it is imperative to conduct a thorough evaluation of the benefits and risks is required. It can be challenging, if not impossible for women suffering from ADHD to stop taking their medication. In a recent article in Archives of Women's Mental Health by psychologist Jennifer Russell, she notes that stopping ADHD medications during pregnancy can increase depression and feelings of isolation. 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 suggests that women who are not sure whether to continue taking medication or discontinue it due to pregnancy, educate their family members, coworkers, and their friends about the condition, its effects on daily functioning, and the advantages of staying on the current treatment regimen. It can also help a woman feel supported in her decision. It is important to note that certain medications are able to pass through the placenta so if the patient decides to stop taking her ADHD medication during pregnancy and breastfeeding, she must be aware of the possibility that traces of the medication could be transferred to the infant. Risk of Birth Defects As the use and use of ADHD medications to treat the symptoms of attention deficit disorder hyperactivity disorder (ADHD) increases, so does concern about the potential effects of these drugs on fetuses. A study that was published in the journal Molecular Psychiatry adds to the existing knowledge about this subject. Utilizing two huge data sets researchers were able examine more than 4.3 million pregnancies to determine whether the use of stimulant medications increased the risk of birth defects. Researchers discovered that although the risk overall is low, first-trimester ADHD medication exposure was associated with slightly higher rates of specific heart defects like ventriculoseptal defect. The researchers of the study could not discover any connection between early use of medication and congenital anomalies like facial deformities or club feet. The results are in agreement with previous studies that showed an insignificant, but small increase in the number of cardiac malformations among women who began taking ADHD medication prior to the time of the time of pregnancy. The risk increased in the latter half of pregnancy when a large number of women stopped taking their medication. Women who took ADHD medications in the first trimester of their pregnancies were also more likely to have caesarean section, low Apgar score following delivery, and a baby who required help breathing at birth. However the authors of the study were unable to eliminate selection bias by limiting the study to women who did not have any other medical issues that could be a contributing factor to these findings. The researchers hope their study will help inform the clinical decisions of physicians who treat pregnant women. They suggest that although a discussion of the risks and benefits is crucial, 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, while stopping the medication is a possibility to consider, it is not recommended because of the high incidence of depression and other mental problems for women who are pregnant or recently gave birth. Research has also shown that women who stop taking their medications will have a difficult adjustment to life without them once the baby is born. Nursing It can be a challenge becoming a mother. Women with ADHD who must work through their symptoms while attending physician appointments and making preparations for the arrival of a baby and adjusting to new household routines are often faced with a number of difficulties. Therefore, many women decide to continue taking their ADHD medications throughout pregnancy. The majority of stimulant medicines are absorbed by breast milk in low quantities, so the risk to nursing infant is very low. However, the rate of medication exposure to the newborn can vary depending on dosage, how often it is administered and the time of the day the medication is administered. Additionally, adult adhd medication enter the infant's system through the gastrointestinal tract or through breast milk. The effect on the health of a newborn isn't fully known. Because of the lack of research, some physicians may recommend stopping stimulant medication during the course of pregnancy. It is a difficult decision for the woman who must weigh the advantages of her medication against the potential risks to the foetus. Until more information is available, GPs should ask all pregnant patients about their experience with ADHD and whether they plan or are taking to take medication during the perinatal period. Many studies have shown that women can continue taking their ADHD medication without risk during pregnancy and breast-feeding. In response, a growing number of patients are choosing to continue their medication. They have found through consultation with their doctor, that the benefits of continuing their current medication outweigh any possible risks. Women who suffer from ADHD who are planning to nurse should seek the advice of a specialist psychiatrist before becoming pregnant. They should review their medications with their prescriber and discuss the advantages and disadvantages of continuing treatment, including non-pharmacological management strategies. Psychoeducation is also required to help pregnant women suffering from ADHD be aware of the symptoms and the underlying disorder. They should also be informed about treatment options and reinforce strategies for coping. This should include a multidisciplinary approach with the GP, obstetricians and psychiatry. Pregnancy counseling should consist of a discussion of a treatment plan for the mother and the child, monitoring of indicators of deterioration, and, if needed, adjustments to the medication regime.