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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 regarding how exposure over time may affect a 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 that more high-quality studies are required. Risk/Benefit Analysis Pregnant women who use ADHD medications need to balance the advantages of taking them against the potential risks to the foetus. Doctors don't have the data needed to provide clear recommendations but they can provide information regarding risks and benefits that help pregnant women make informed choices. A study published in Molecular Psychiatry concluded that women who were taking ADHD medication during their early pregnancy were not at greater risk of fetal malformations, or structural birth defects. Researchers conducted a large, population-based case-control study to evaluate the incidence of major structural birth defects in babies born to mothers who had taken stimulants during the early stages of pregnancy, and those who did not. Pediatric cardiologists, clinical geneticists and other experts looked over the cases to ensure that the classification was accurate and to reduce any bias. However, the study had its limitations. The most important issue was that they were unable to distinguish the effects of the medication from the disorder that is underlying. This makes it difficult for researchers to establish whether the small associations observed among the groups that were exposed to medication use or caused by comorbidities. Additionally the study did not study the long-term outcomes of offspring. The study did show 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 were born without any medication or had taken off their medication prior to or during pregnancy. The reason for this was central nervous system disorders. The increased risk of admission was not affected by the stimulant medication that was used during pregnancy. Women who were taking stimulant ADHD medications during pregnancy also had a higher risk of having a caesarean section or the baby was not scoring well on the Apgar scale (less than 7). These increases did not appear to be influenced by the type of medication that was used during pregnancy. The research suggests 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 the 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 can lessen the effects of her disorder on her daily life and relationships. Interactions with Medication Many doctors are faced with the decision of whether to keep treatment or stop as more women are diagnosed with ADHD. These decisions are usually made without clear and authoritative evidence. Instead, doctors must take into account their own experience and experience, as well as the experiences of other doctors and the research on the topic. Particularly, the issue of possible risks to the baby can be a challenge. The research that has been conducted on this topic is based on observation instead of controlled studies and the results are contradictory. Most studies restrict their analysis to live births, which can underestimate the severity of teratogenic effects which can cause terminations or abortions of pregnancy. The study discussed in this journal club addresses these issues by examining data on both live and deceased births. Conclusion Some studies have revealed an association between ADHD medications and certain birth defects, other studies have not established a link. The majority of studies show that there is a neutral, or slight negative impact. In every case it is imperative to conduct a thorough analysis of the potential risks and benefits must be performed. It can be difficult, if not impossible for women with ADHD to stop taking their medication. In a recent article published in Archives of Women's Mental Health by psychologist Jennifer Russell, she notes that stopping ADHD medications during pregnancy can lead to depression and feelings of being isolated. Furthermore, a loss of medication can interfere with the ability to do job-related tasks and drive safely which are essential aspects of a normal life for a lot of people with ADHD. She recommends women who are unsure about whether to continue or stop medication in light of their pregnancy consider informing family members, friends and colleagues on the condition, its impact on daily life, and the benefits of keeping the current treatment plan. It can also help women feel more confident in her decision. It is also worth noting that certain medications are able to be absorbed through the placenta so if the patient decides to discontinue her ADHD medication during pregnancy and breastfeeding, she must be aware that the effects of the drug can be transferred to the infant. Risk of Birth Defects As the use of ADHD drugs to treat symptoms of attention deficit hyperactivity disorder (ADHD) increases there are concerns over the impact that these drugs might have on fetuses. A recent study published in the journal Molecular Psychiatry adds to the existing information on this topic. With two massive data sets researchers were able to look at more than 4.3 million pregnancies and determine whether 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, such as ventriculoseptal defect. The researchers of the study found no link between early use of medication and congenital abnormalities such as facial clefting or club foot. The results are in the same vein as previous studies that have shown a small, but significant increase in the number of cardiac malformations among women who began taking ADHD medication before the birth of their child. The risk was higher during the latter part of pregnancy, as many women are forced to stop taking their medication. Women who took ADHD medication in the first trimester of their pregnancy were also more likely to undergo caesarean sections, a low Apgar score after delivery and a baby that required breathing assistance at birth. The researchers of the study could not remove bias in selection since they restricted the study to women who did not have any other medical conditions that might have contributed to the findings. The researchers hope their research will serve to inform the clinical decisions of doctors who treat pregnant women. The researchers advise that, while discussing the risks and benefits are important, the decision regarding whether or not to stop medication should be based on the severity of each woman's ADHD symptoms and her needs. adhd adults medication warn that, while stopping the medication is a possibility to look into, it is not advised because of the high incidence of depression and mental health issues for women who are pregnant or have recently given birth. Additionally, research suggests that women who stop taking their medications will have a harder adjustment to life without them once the baby is born. Nursing The responsibilities that come with being a new mother can be overwhelming. Women who suffer from ADHD who have to manage their symptoms while attending physician appointments, getting ready for the arrival of a baby and getting used to new routines at home may face a lot of challenges. This is why many women choose to continue taking their ADHD medication throughout the pregnancy. The risk for breastfeeding infant is not too high since the majority of stimulant medications is absorbed through breast milk at low levels. However, the amount of exposure to medication by the infant can differ based on dosage, frequency it is administered and at what time it is administered. Additionally, different drugs enter the infant's system via the gastrointestinal tract or through breast milk. The impact of these medications on the health of a newborn is not completely known. Because of the lack of research, some doctors may be inclined to discontinue stimulant drugs during the course of pregnancy. This is a difficult decision for the patient, who must balance the benefit of continuing her medication against the potential risks to the foetus. In the meantime, until more information is available, GPs may inquire about pregnant patients if they have any history of ADHD or if they intend to take medication during the perinatal stage. A growing number of studies have revealed that the majority of women are able to safely continue their ADHD medication during pregnancy and breastfeeding. In response, a growing number of patients are choosing to do so. They have discovered through consultation with their physicians that the benefits of keeping their current medication outweigh risk. Women with ADHD who are planning to nurse should seek the advice of a specialist psychiatrist prior to becoming pregnant. They should discuss their medication with their doctor and discuss the pros and cons of continuing treatment. This includes non-pharmacological strategies. Psychoeducation is also required to help pregnant women suffering from ADHD be aware of their symptoms and underlying disorder Learn about the available treatment options and reinforce existing coping strategies. This should be a multidisciplinary effort including obstetricians, GPs, and psychiatrists. Pregnancy counseling should consist of a discussion of a treatment plan for the mother as well as the child, monitoring of signs of deterioration and, if needed, adjustments to the medication regimen.