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ADHD Medication During Pregnancy and Breastfeeding Women with ADHD must make a difficult decision on whether to keep or stop taking ADHD medication during pregnancy and breast-feeding. 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 the uterus don't develop neurological developmental conditions like impaired vision or hearing, febrile seizures, or IQ impairment. The authors acknowledge that more high quality research is needed. Risk/Benefit Analysis Pregnant women who take ADHD medications must weigh the advantages of taking them against potential risks to the fetus. The doctors don't have the information to provide clear recommendations but they can provide information about risks and benefits to help pregnant women make informed decisions. A study published in Molecular Psychiatry found that women who were taking ADHD medications in early pregnancy did not have a significantly increased risk of fetal heart malformations or major birth defects that are structural. Researchers conducted a large sample-based case control study to assess the frequency of structural defects that were major in infants who were born to mothers who were taking stimulants during pregnancy. Clinical geneticists and pediatric cardiologists reviewed the cases to ensure an accurate case classification and to limit the possibility of bias. However, the study was not without its flaws. The researchers were unable, in the first place to differentiate the effects triggered by the medication from the disorder. This limitation makes it difficult to know whether the small differences observed in the exposed groups result from medication use or confounding by comorbidities. Researchers also did not look at the long-term effects for the offspring. www.iampsychiatry.uk showed that babies whose mothers had taken ADHD medication during pregnancy had a higher risk of admission to the neonatal care unit (NICU) as compared to mothers who did not 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 higher risk of admission did not appear to be influenced by which stimulant medications were used during pregnancy. Women who took stimulant ADHD medication during pregnancy also had an increased risk of having a caesarean section or having a baby born with a low Apgar score (less than 7). These increases didn't seem to be influenced by the kind of medication used during pregnancy. The research suggests that the risk of a small amount with the use of ADHD medications during the early stages of pregnancy may be offset by the greater benefit for both mother and child of continuing treatment for the woman's condition. Physicians should speak with their patients about this issue and, if possible, help them develop coping skills that can lessen the effects of her disorder on her daily life and relationships. Medication Interactions Many doctors are confronted with the dilemma of whether to keep treatment or stop it during pregnancy as more women are diagnosed with ADHD. These decisions are usually taken without clear and authoritative evidence. Instead, doctors must weigh their own knowledge and experience, as well as the experiences of other doctors, and the research that has been conducted on the subject. In particular, the issue of possible risks to the infant can be difficult. The research on this issue is based on observation rather than controlled studies and many of the findings are in conflict. In addition, most studies limit their analysis to live births, which could undervalue the serious teratogenic effects that can cause abortion or termination of the pregnancy. The study discussed in this journal club addresses these shortcomings by looking at data from both live and deceased births. The conclusion The conclusion: While some studies have shown that there is a positive correlation between ADHD medications and the risk of certain birth defects, others have found no such relationship, and most studies have a neutral or slightly negative effect. In the end, a careful risk/benefit analysis must be conducted in every instance. It can be difficult, if not impossible for women with 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 cause depression and feelings of loneliness. The loss of medication can also affect the ability to safely drive and complete work-related tasks, which are essential aspects of normal life for people with ADHD. She suggests that women who are unsure about whether to continue or stop taking medication because of their pregnancy, consider educating family members, friends and colleagues about the condition, its impact on daily life, and the advantages of continuing the current treatment regimen. It can also help women feel confident about her decision. It is important to remember that certain drugs can be absorbed through the placenta so if the patient decides to stop her ADHD medication during pregnancy and breastfeeding, she must be aware that traces of the drug can be transferred to the infant. Birth Defects and Risk of As the use and abuse of ADHD medication to treat symptoms of attention deficit hyperactivity disorder (ADHD) is increasing as does the concern about the potential effects of these drugs on foetuses. A recent study published in the journal Molecular Psychiatry adds to the existing knowledge on this subject. Researchers utilized two massive data sets to examine over 4.3 million pregnancies and determine whether stimulant medications increased the risk of birth defects. Although the risk overall remains low, the scientists did find that first-trimester exposure to ADHD medications was linked to an increased risk of certain heart defects like ventriculo-septal defects (VSD). The authors of the study found no association between early medication use and other congenital abnormalities, such as facial clefting or club foot. The results are in line with previous studies that showed the existence of a slight, but significant increase in cardiac malformations for women who started taking ADHD medication prior to the time of the birth of their child. The risk grew in the later part of pregnancy, when a lot of women begin to discontinue their ADHD medications. Women who were taking ADHD medication during the first trimester were more likely require a caesarean birth, have a low Apgar after delivery, and had a baby that required breathing assistance after birth. The researchers of the study were unable to remove bias in selection since they limited their study to women who did not have any other medical conditions that might have contributed to the findings. The researchers hope their study will aid in the clinical decisions of doctors who treat pregnant women. The researchers advise that while discussing the risks and benefits are important, the decision on whether to continue or stop taking medication should be according to the severity of each woman's ADHD symptoms and her requirements. The authors also warn that while discontinuing the medications is an option, it isn't a recommended practice because of the high incidence of depression and other mental health problems in women who are pregnant or recently post-partum. Further, the research suggests that women who choose to stop taking their medications are more likely to experience difficulties adapting to life without them after the birth of their baby. Nursing The responsibilities that come with being a new mom can be overwhelming. Women with ADHD who have to manage their symptoms while attending doctor appointments as well as preparing for the arrival of a baby and adjusting to new household routines can experience severe challenges. Therefore, many women elect to continue taking their ADHD medications throughout pregnancy. The risk for breastfeeding infant is minimal because the majority of stimulant medication is absorbed through breast milk in low amounts. However, the rate of medication exposure to the newborn may 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 via the gastrointestinal tract, or through breast milk. The impact on the health of a newborn isn't fully understood. Some doctors may stop taking stimulant medication during a woman's pregnancy due to the lack of research. This is a complicated decision for the patient, who must weigh the benefits of continuing her medication with the potential risks to the fetus. As long as there is no more information, doctors should ask all pregnant patients about their experience with ADHD and whether they are planning or taking to take medication during the perinatal time. Many studies have shown that women can continue to take their ADHD medication in a safe manner during pregnancy and breast-feeding. In response, an increasing number of patients are choosing to do so. They have found through consultation with their doctor that the benefits of continuing their current medication far outweigh any potential risks. Women with ADHD who are planning to nurse should seek advice from an expert psychiatrist prior to becoming pregnant. They should discuss their medication with their doctor as well as the pros and cons of continuing treatment. This includes non-pharmacological methods. Psychoeducation is also needed to help pregnant women with ADHD recognize the signs and the underlying disorder. They should also be informed about treatment options and build strategies for coping. This should be an approach that is multidisciplinary, including the GP as well as obstetricians, psychiatry and obstetricians. Counselling for pregnancy should include the discussion of a plan for management for both the mother and child, as well as monitoring for signs of deterioration, and the need for adjustments to the medication regimen.