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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 breastfeeding. There aren't many studies regarding how exposure over time may affect a pregnant fetus. A study recently 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 that more high quality studies are needed. Risk/Benefit Analysis Pregnant women who use ADHD medications must weigh the benefits of using them against the risks to the fetus. Physicians don't have the data needed to give clear guidelines but they can provide information about benefits and risks that can help pregnant women make informed decisions. A study published in Molecular Psychiatry found that women who took ADHD medications during their early pregnancy did not have an higher risk of fetal cardiac malformations or major birth defects that are structural. Researchers conducted a massive sample-based case control study to compare the incidence of major structural defects in infants who were born to mothers who took stimulants during pregnancy. Pediatric cardiologists, clinical geneticists and other experts reviewed the cases in order to ensure that the classification was correct and to eliminate any bias. The study of the researchers was not without limitations. Most important, they were not able to differentiate the effects of the medication from those of the disorder that is underlying. This limitation makes it difficult to know whether the limited associations observed in the exposed groups are due to the use of medication or the confounding effect of comorbidities. adhd without medication did not study the long-term effects for the offspring. The study did show that babies whose mothers had taken ADHD medications 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 cut back on their medications 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 affected by the type of stimulant medications were taken during pregnancy. Women who took stimulant ADHD medication during pregnancy were also at an increased chance of having a caesarean birth or having a child with a low Apgar score (less than 7). These increases did appear to be unrelated to the type of medication used during pregnancy. Researchers suggest that the small risks posed by the use of ADHD medications in early pregnancies can be offset by greater benefits for mother and baby from continuing treatment for the woman's condition. Doctors should discuss with their patients about this and try to help them develop coping skills that may reduce the impact of her disorder in her daily life and relationships. Medication Interactions More and more doctors are confronted with the dilemma of whether to maintain treatment or stop as more women are diagnosed with ADHD. Most of the time, these decisions are taken in the absence of clear and authoritative evidence either way, so physicians must weigh their knowledge from their own experiences, those of other doctors, and what the research suggests about the subject, along with their best judgment for each individual patient. Particularly, the issue of potential risks to the baby can be tricky. Many studies on this issue are based on observations rather than controlled research and their conclusions are often contradictory. The majority of studies restrict their analysis to live births, which may underestimate the severity of teratogenic effects leading to abortions or terminations of pregnancy. The study that is discussed in the journal club addresses these issues, by examining both data on live and deceased births. The conclusion The conclusion: While some studies have found that there is a positive correlation between ADHD medications and the possibility of certain birth defects, others have found no connection, and most studies show a neutral or even slightly negative effect. In the end, a careful risk/benefit assessment must be done in each situation. For women suffering from ADHD and ADD, the decision to stop taking medication is difficult, if not impossible. In a recent article in Archives of Women's Mental Health, psychologist Jennifer Russell notes that stopping ADHD medication during pregnancy can cause depression, feelings of loneliness, and family conflict for these patients. Additionally, the loss of medication may affect the ability to do work-related tasks and safely drive that are crucial aspects of daily life for many people suffering from ADHD. She recommends women who are unsure about whether to keep or stop taking medication because 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 regimen. Educating them can also aid in ensuring that the woman feels supported in her struggle with her decision. It is important to remember that certain drugs can be absorbed through the placenta so if the patient decides to discontinue her ADHD medication during pregnancy and breastfeeding, she must be aware of the possibility that traces of the medication could be passed on to the baby. Birth Defects and Risk of As the use and abuse of ADHD drugs to treat symptoms of attention deficit disorder hyperactivity disorder (ADHD) increases 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 body of knowledge on this subject. Researchers used two massive data sets to study more than 4.3 million pregnant women and determine if stimulant medication use increased the risk of birth defects. Researchers found that while the risk overall is low, the first trimester ADHD medication use was associated with slightly higher rates of specific heart defects such as ventriculoseptal defect. The researchers of the study found no connection between the use of early medications and other congenital anomalies, like facial clefting, or club foot. The results are in line with previous studies revealing an increase, but not significant, in the risk of cardiac malformations in women who started taking ADHD medications prior to the time of the time of pregnancy. The risk increased in the latter stages of pregnancy, when a lot of women began to stop taking their medication. Women who took ADHD medication during the first trimester were more likely to need a caesarean or have a low Apgar after delivery, and have a baby that needed breathing assistance after birth. However the authors of the study were not able to eliminate bias due to selection by restricting the study to women who didn't have any other medical conditions that could be a contributing factor to these findings. The researchers hope their research will aid in the clinical decisions of doctors who see pregnant women. They advise that while discussing the risks and benefits is crucial, the decision to stop or maintain medication should be based on each woman's needs and the severity of her ADHD symptoms. The authors also caution that, while stopping the medication is an alternative, it is not a recommended practice because of the high rate of depression and other mental health issues among women who are pregnant or recently post-partum. Additionally, research suggests that women who stop taking their medications will have a tough adjustment to life without them once the baby is born. Nursing The responsibilities that come with being a new mom can be overwhelming. Women suffering from ADHD may face a lot of challenges when they have to manage their symptoms, go to doctor appointments, prepare for the birth of their child and adjust to new routines. As such, many women elect to continue taking their ADHD medications throughout pregnancy. The majority of stimulant medicines are absorbed through breast milk in very small quantities, so the risk for breastfeeding infant is minimal. However, the rate of medication exposure to the newborn may differ based on dosage, how often it is taken and the time of day the medication is administered. Additionally, different medications enter the infant's system differently through the gastrointestinal tract as well as breast milk and the impact of this on a newborn is not yet fully understood. Due to the absence of research, some doctors may be inclined to discontinue stimulant medications during the course of pregnancy. This is a difficult decision for the mother, who must weigh the advantages of taking her medication as well as the risk to the foetus. In the meantime, until more information is available, doctors should ask all pregnant patients about their history of ADHD and whether they plan or are taking to take medication during the perinatal period. A growing number of studies have shown that women can continue to take their ADHD medication during pregnancy and while breastfeeding. In response, a rising number of patients are choosing to do so. They have discovered through consultation with their physicians that the benefits of continuing their current medication outweigh any potential risks. Women with ADHD who are planning to nurse should seek advice from a specialist psychiatrist before becoming pregnant. They should discuss their medication with their physician and discuss the pros and cons of continued treatment, including non-pharmacological strategies. Psychoeducation should also be provided to help women with ADHD understand their symptoms and the root cause Learn about the available treatment options and reinforce existing coping strategies. This should involve an approach that is multidisciplinary, including the GP doctors, obstetricians and psychiatrists. Pregnancy counseling should include discussion of a treatment plan for the mother as well as the child, and monitoring for indicators of deterioration, and, if needed modifications to the medication regime.