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ADHD Medication During Pregnancy and Breastfeeding The decision to stop or keep ADHD medications during pregnancy and nursing is a challenge for women suffering from the condition. Little data exists about how long-term exposure to these drugs may affect the fetus. A recent study published in Molecular Psychiatry demonstrates that children exposed to ADHD medication during pregnancy do not develop neurological issues such as hearing loss or vision, febrile seizures or IQ impairment. The authors acknowledge the need for higher-quality research. 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 enough data to give clear advice but they can provide information about risks and benefits to aid pregnant women in making informed decisions. adhd medication online published in Molecular Psychiatry found that women who used ADHD medications in early pregnancy did not have an increased risk of fetal heart malformations or major structural birth defects. Researchers conducted a large 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, and those who did not. Pediatric cardiologists, clinical geneticists and other experts reviewed the cases in order to make sure that the classification was accurate and to eliminate any bias. However, the study was not without its flaws. The researchers were unable to, in the first place to distinguish the effects triggered 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 the use of medications or caused by the presence of comorbidities. Additionally the study did not examine long-term offspring outcomes. The study found that infants whose mothers had taken ADHD medication during pregnancy had a higher risk of admission to the neonatal care unit (NICU), compared to mothers who didn't take any medication during pregnancy, or had quit taking the medication prior to or during pregnancy. The reason for this was central nervous system disorders. The higher risk of admission was not affected by the stimulant medication used during pregnancy. Women who were taking stimulant ADHD medications during pregnancy also had a higher likelihood of having a caesarean section or a baby that scored low on the Apgar scale (less than 7). These increases appear to be unrelated to the type of medication used during pregnancy. Researchers suggest that the small risk of using ADHD medications during early pregnancies may be offset by the more beneficial outcomes for both mother and baby of continuing treatment for the woman’s disorder. Physicians should discuss this with their patients and, where they are able, assist them in developing strategies to improve coping skills that may minimize the effects of her disorder on her daily functioning and relationships. Interactions with Medication Doctors are increasingly faced with the decision of whether to continue treatment or stop as more women are diagnosed with ADHD. Most of the time, these decisions are made without solid and reliable evidence regardless, so doctors must weigh their knowledge from their own experiences, those of other doctors, and what the research suggests on the subject and their own judgments for each individual patient. Particularly, the subject of potential risks for the infant can be difficult. The research on this subject is based on observations rather than controlled studies, and a lot of the results are in conflict. Additionally, the majority of studies limit their analysis to live births, which may underestimate severe teratogenic effects that cause abortion or termination of the pregnancy. The study that is discussed in this journal club addresses these issues by examining data on both live and deceased births. The conclusion The conclusion: While certain studies have demonstrated that there is a positive correlation between ADHD medications and the risk of certain birth defects, others have not found any evidence of a link and the majority of studies show a neutral or even slight negative effect. Therefore, a careful risk/benefit analysis must be done in each case. It isn't easy, but not impossible, for women suffering from ADHD to stop taking their medication. In a recent piece published in the Archives of Women's Mental Health by psychologist Jennifer Russell, she notes that stopping ADHD medications during pregnancy can increase depression and feelings of loneliness. The loss of medication can affect the ability to safely drive and to perform work-related tasks which are essential aspects of everyday life for those with ADHD. She suggests women who are unsure about whether or not to stop medication in light of their pregnancy, consider the possibility of educating friends, family members and colleagues about the condition, its effects on daily life, and the benefits of keeping the current treatment plan. It can also aid in ensuring that the woman feels supported in her struggle with her decision. Some medications can pass through the placenta. If the patient decides to stop taking her ADHD medication while pregnant and breastfeeding, it is important to be aware that the medication may be transferred to her infant. Birth Defects and Risk of As the use and misuse of ADHD medications to treat the symptoms of attention deficit hyperactivity disorder (ADHD) increases, so does concern about the possible effects of the drugs on the fetuses. A study that was published in the journal Molecular Psychiatry adds to the body of knowledge on this subject. With two massive data sets researchers were able to look at more than 4.3 million pregnancies and see whether stimulant medications increased the risk of birth defects. While the overall risk remains low, the scientists did find that first-trimester exposure to ADHD medications was associated with an increased risk of certain heart defects such as ventriculoseptal defect (VSD). The researchers of the study didn't discover any connection between early use of medication and other congenital anomalies like facial deformities or club feet. 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 started taking ADHD medication before pregnancy. This risk increased during the latter stages of pregnancy when a large number of women began to stop taking their medication. Women who used ADHD medications during the first trimester of their pregnancies were also more likely to have caesarean sections, a low Apgar score after delivery and a baby that required breathing assistance during birth. The researchers 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. Researchers hope that their study will inform physicians when they see pregnant women. The researchers recommend that, while discussing the risks and benefits are important, the choice on whether to continue or stop medication should be according to the severity of each woman's ADHD symptoms and her needs. The authors warn that, although stopping the medication is an option to think about, it isn't advised due to the high prevalence of depression and other mental disorders in women who are expecting or have recently given birth. Further, research shows that women who stop taking their medication will have a harder transitioning to life without them after the baby is born. Nursing It can be overwhelming to become a mother. Women who suffer from ADHD who have to manage their symptoms while attending physician appointments as well as getting ready for the arrival of a baby and adapting to new routines in the home are often faced with a number of difficulties. This is why many women decide to continue taking their ADHD medications throughout the course of pregnancy. The risk for breastfeeding infant is minimal because the majority of stimulant medication passes through breast milk in low amounts. The rate of medication exposure will vary based on the dosage, frequency of administration and the time of day. In addition, various medications are introduced into the baby's system through the gastrointestinal tract, or through breast milk. The impact of these medications on a newborn's health is not fully comprehended. Due to the absence of evidence, some doctors may recommend stopping stimulant medication during a woman's pregnancy. This is a difficult decision for the patient, who must weigh the benefits of keeping her medication against the potential dangers to the embryo. Until more information is available, GPs should ask all pregnant patients about their history of ADHD and if they are planning or taking to take medication during the perinatal period. A increasing number of studies have proven that the majority of women are able to safely continue taking their ADHD medication while they are pregnant and nursing. As a result, more and more patients opt to do this, and after consulting with their doctor, they have found that the benefits of continuing their current medication outweigh any risks. It is crucial for women suffering from ADHD who are considering breastfeeding to seek a specialist psychiatrist's guidance prior to becoming pregnant. They should discuss the medication they are taking with their physician, and the pros and cons for continuing treatment. This includes non-pharmacological strategies. Psychoeducation should also be offered to help women with ADHD understand their symptoms and underlying disorder and learn about treatment options and reinforce existing strategies for managing. This should be a multidisciplinary effort with the GPs, obstetricians and psychiatrists. Pregnancy counseling should consist of a discussion of a treatment plan for the mother and child, as well as monitoring for signs of deterioration, and, if necessary, adjustments to the medication regime.