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ADHD Medication During Pregnancy and Breastfeeding Women with ADHD face a difficult decision about whether to continue or stop taking ADHD medication during pregnancy and breast-feeding. There are few data on how exposure to ADHD for a long time could 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 impaired hearing or vision, febrile seizures, or IQ impairment. The authors acknowledge that more high quality studies are required. Risk/Benefit Analysis Pregnant women who take ADHD medications need to balance the benefits of using them against the risks to the fetus. Physicians don't have the necessary data to give clear guidelines, but they can provide information about the risks and benefits to assist pregnant women in making informed choices. A study published in Molecular Psychiatry concluded that women who were taking ADHD medication during early pregnancy did not have a higher risk of fetal malformations or structural birth defects. Researchers conducted a massive 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, pediatric cardiologists and other experts looked over the cases to confirm that the classification was accurate and to minimize any bias. The study conducted by the researchers was not without limitations. Researchers were unable, in the first place to differentiate the effects triggered by the medication from the disorder. This limitation makes it difficult to determine whether the limited associations observed in the exposed groups are due to the use of medication or the confounding effect of comorbidities. Additionally, the researchers did not study long-term offspring outcomes. The study revealed that babies whose mothers took ADHD medication during pregnancy were at a slightly higher chance of being admitted to the neonatal care unit (NICU) in comparison to those whose mothers did not use any medication during pregnancy, or had discontinued taking their medication prior to or during pregnancy. This increase was due to central nervous system-related disorders, and the increased risk for admission was not found to be affected by the type of stimulant medications were taken during pregnancy. Women who took 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. Researchers suggest that the minor risks posed by the use of ADHD medications in early pregnancies may be offset by the more beneficial outcomes for both mother and baby from continuing treatment for the woman's disorder. Physicians should speak with their patients about this and try to help them develop coping skills that can lessen the impact of her disorder in her daily functioning and her relationships. Medication Interactions Doctors are increasingly faced with the decision of whether to maintain treatment or stop it during pregnancy as more women are diagnosed with ADHD. Often, these decisions are made without solid and reliable evidence either way, so physicians must weigh what they know, the experiences of other doctors, and what the research suggests about the subject as well as their best judgment for each patient. The issue of possible risks for infants can be difficult to determine. The research on this subject is based on observations instead of controlled studies and the results are contradictory. Furthermore, most studies restrict their analysis to live births, which may underestimate severe teratogenic effects that result in abortion or termination of the pregnancy. The study presented in this journal club addresses these issues by looking at data from both live and deceased births. Conclusion Some studies have shown an association between ADHD medications and certain birth defects, other studies have not established a link. Most studies show an unintended, or slightly negative, effect. In all cases it is imperative to conduct a thorough analysis of the potential risks and benefits should be conducted. It isn't easy, but not impossible, for women with ADHD to stop taking their medication. In a recent article 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 being isolated. The loss of medication can also affect the ability to drive safely and to perform work-related tasks which are vital aspects of daily life for those with ADHD. She suggests that women who are unsure whether to continue taking medication or discontinue it due to pregnancy educate family members, colleagues, and acquaintances about the condition, its impact on daily functioning and the advantages of staying on the current treatment regimen. Educating them can also aid in ensuring that the woman feels supported as she struggles with her decision. It is important to remember that some drugs can be absorbed through the placenta so if a woman decides to stop taking her ADHD medication during pregnancy and breastfeeding, she should be aware that traces of the drug could be transferred to the infant. Birth Defects Risk As the use and misuse of ADHD drugs to treat symptoms of attention deficit disorder hyperactivity disorder (ADHD), increases, so does concern about the potential adverse effects of the drugs on the fetuses. A study that was published in the journal Molecular Psychiatry adds to the existing information on this topic. adult add medications used two huge data sets to study more than 4.3 million pregnancy and determine whether stimulant medications caused birth defects. Although the risk overall remains low, the scientists found that exposure in the first trimester to ADHD medications was linked to an increase in the risk of certain heart defects, such as ventriculoseptal defect (VSD). The researchers behind the study found no connection between early medication use and other congenital anomalies, like facial clefting, or club foot. The results are in the same vein as previous studies that showed an insignificant, but small increase in cardiac malformations for women who started taking ADHD medication prior to pregnancy. The risk grew in the latter half of pregnancy, when many women begin to discontinue their medication. Women who took ADHD medication in the first trimester were more likely require a caesarean birth or have a low Apgar after delivery and had a baby that required help breathing at birth. The authors of the study were unable to eliminate selection bias because they limited the study to women without other medical conditions that could have contributed to the findings. The researchers hope their study will serve to inform the clinical decisions of physicians who encounter pregnant women. The researchers recommend that while discussing the risks and benefits are important, the decision on whether to continue or stop medication should be based on the severity of each woman's ADHD symptoms and her requirements. The authors also caution that even though stopping the medication is an option, it isn't an option to consider due to the high incidence of depression and other mental health issues in women who are pregnant or post-partum. Additionally, research suggests that women who stop taking their medication will have a harder transitioning to life without them after the baby is born. Nursing The responsibilities of a new mother can be overwhelming. Women who suffer from ADHD are often faced with a number of difficulties when they have to manage their symptoms, attend doctor appointments, prepare for the birth of a child and adjust to new routines. Therefore, many women decide to continue taking their ADHD medications throughout the course of pregnancy. The majority of stimulant medications are absorbed through breast milk in very small amounts, therefore the risk for infant who is breastfeeding is low. However, the amount of exposure to medication by the newborn can vary depending on dosage, how often it is administered, and at what time it is administered. In addition, various drugs enter the infant's system through the gastrointestinal tract or breast milk. The impact on a newborn's health is not fully understood. Some doctors may decide to stop stimulant medications during a woman's pregnancy due to the absence of research. It is a difficult decision for the mother, who must weigh the advantages of continuing her medication against the risk to the fetus. In the meantime, until more information is available, GPs can ask pregnant patients if they have a background of ADHD or if they plan to take medication in the perinatal period. Numerous studies have demonstrated that women can continue to take their ADHD medication in a safe manner during pregnancy and while breast-feeding. In the end, an increasing number of patients opt to do this, and after consulting with their doctor, they have found that the benefits of continuing their current medication exceed any risk. It is crucial for women suffering from ADHD who are considering breastfeeding to seek out a specialist psychiatrist's guidance prior to becoming pregnant. They should review their medications with their prescriber and discuss the advantages and disadvantages of continued treatment, including non-pharmacological strategies. Psychoeducation should also be offered to help pregnant people with ADHD understand their symptoms and the root cause Learn about the available treatment options and strengthen existing strategies for coping. This should be a multidisciplinary approach, which includes the GP, obstetricians and psychiatry. Counselling for pregnancy should include the discussion of a treatment plan for both mother and child, monitoring for signs of deterioration and when necessary, making adjustments to the medication regimen.