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ADHD Medication During Pregnancy and Breastfeeding Women with ADHD have to make a difficult choice on whether to keep or stop taking ADHD medication during pregnancy and breast-feeding. There isn't much information on how long-term exposure to these medications may affect the fetus. A study recently published in Molecular Psychiatry shows that children exposed to ADHD medication during the uterus do not develop neurological conditions like hearing or vision impairment seizures, febrile seizures or IQ impairment. The authors acknowledge that more high-quality studies are required. Risk/Benefit Analysis Women who are pregnant and taking ADHD medications need to balance the advantages of taking them against potential risks to the fetus. Physicians don't have the data to provide clear recommendations but they can provide information on risks and benefits to assist pregnant women to make informed decisions. A study published in Molecular Psychiatry concluded that women who took ADHD medication during early pregnancy did not have a greater risk of fetal malformations or structural birth defects. Researchers used a large sample-based case control study to examine the prevalence of structural defects that were major in infants who were born to mothers who took stimulants during pregnancy. Clinical geneticists and pediatric cardiologists examined the cases to ensure correct classification of the cases and to reduce the possibility of bias. However, the study was not without its flaws. Researchers were unable, in the first place, to separate the effects caused by the medication from the disorder. This limitation makes it difficult for researchers to establish whether the small differences observed between the groups exposed were due to medication use, or if they were affected by co-morbidities. In addition the researchers did not look at the long-term outcomes of offspring. The study did reveal that infants whose mothers took ADHD medications during pregnancy were at a greater risk of being admitted to the neonatal intensive care unit (NICU) than those who whose mothers did not take any medication or taken off their medication prior to or during pregnancy. The reason for this was central nervous system disorders. The higher risk of admission was not influenced by the stimulant medications used during pregnancy. Women who were taking stimulant ADHD medication during pregnancy also had an increased chance of having a caesarean birth or having a baby born with an low Apgar score (less than 7). These increases appear to be unrelated to the type of medication taken 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 for both mother and child from continued treatment for the woman's condition. Physicians should discuss the issue with their patients and, when possible, help them develop strategies to improve coping skills that can lessen the impact of her disorder on her daily functioning and relationships. Interactions with Medication More and more doctors are faced with the decision of whether to continue treatment or stop as more women are diagnosed with ADHD. These decisions are often taken without clear and authoritative evidence. Instead, physicians must weigh their own knowledge in conjunction with the experiences of other physicians and the research on the subject. Particularly, the issue of possible risks to the baby can be a challenge. Many of the studies on this subject are based on observational evidence rather than controlled research and their findings are often contradictory. Additionally, the majority of studies limit their analysis to live births, which could undervalue the serious teratogenic effects that can lead to abortion or termination of the pregnancy. The study discussed in the journal club addresses these limitations, by examining both information on deceased and live births. The conclusion The conclusion: While certain studies have demonstrated an association between ADHD medications and the risk of certain birth defects, other studies have not found any evidence of a link, and most studies have a neutral or slight negative effect. In the end, a careful risk/benefit analysis is required in every instance. medication adhd adults can be difficult, if not impossible, for women with ADHD to stop taking their medication. In fact, in an article published in the Archives of Women's Mental Health psychologist Jennifer Russell notes that stopping ADHD medication during pregnancy can cause depression, feelings of isolation and family conflict for patients with ADHD. A decrease in medication could affect the ability to safely drive and complete work-related tasks, which are essential aspects of daily life for those suffering from ADHD. She suggests that women who aren't sure whether to continue taking medication or stop it due to their pregnancy should educate family members, coworkers and their friends about the condition, the effects on daily functioning, and the benefits of keeping the current treatment regimen. Educating them can also make the woman feel more comfortable as she struggles with her decision. It is important to note that certain medications can pass through the placenta therefore, if a patient decides to stop her ADHD medication during pregnancy and breastfeeding, she must be aware that traces of the medication could be transferred to the child. Birth Defects Risk As the use and misuse of ADHD medications to treat the symptoms of attention deficit hyperactivity disorder (ADHD) increases the concern over the possible effects of the drugs on fetuses. A study that was published in the journal Molecular Psychiatry adds to the existing information on this topic. Using two massive data sets researchers were able look at more than 4.3 million pregnancies and see whether the use of stimulant medications increased the risk of birth defects. Researchers found that while the risk overall is low, the first trimester ADHD exposure to medication was associated with slightly higher risk of specific heart defects like ventriculoseptal defects. The researchers of the study found no connection between the use of early medications and other congenital anomalies, such as facial clefting or club foot. The results are in the same vein as previous studies which showed a small, but significant increase in the number of cardiac malformations among women who started taking ADHD medication prior to the time of pregnancy. medication for add in adults increased in the later part of pregnancy, when many women begin to discontinue their medication. Women who took ADHD medication during the first trimester were more likely require a caesarean birth, have a low Apgar after birth and had a baby that required help breathing after birth. However the researchers of the study were not able to eliminate selection bias by restricting the study to women who didn't have any other medical issues that could have contributed to these findings. The researchers hope their research will help inform the clinical decisions of physicians who see pregnant women. The researchers recommend that while discussing risks and benefits are important, the decision regarding whether or not to stop taking medication should be in light of the severity of each woman's ADHD symptoms and the needs of the woman. The authors caution that, although stopping the medication is an option to think about, it isn't advised due to the high rate depression and mental health issues in women who are expecting or recently gave birth. Research has also shown that women who stop taking their medication will have a difficult time adjusting to a 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 deal with their symptoms while attending doctor appointments, getting ready for the arrival of a baby and adjusting to new household routines can experience severe challenges. As such, many women elect to continue taking their ADHD medications throughout the course of pregnancy. The risk to breastfeeding infant is minimal because the majority of stimulant medication is absorbed through breast milk in low amounts. The rate of medication exposure will vary based on the dosage and frequency of administration as well as time of day. Additionally, different medications enter the baby's system differently through the gastrointestinal tract and breast milk. The impact of this on a newborn infant is not well known. Some doctors may decide to stop stimulant medication during a woman’s pregnancy due to the lack of research. This is a difficult decision for the patient, who must balance the benefits of keeping her medication against the potential dangers to the embryo. Until more information becomes available, doctors may ask pregnant patients if they have any background of ADHD or if they are planning to take medication during the perinatal period. Numerous studies have proven that women can continue taking their ADHD medication without risk during pregnancy and while breast-feeding. In response, an increasing number of patients are opting to continue their medication. They have discovered after consulting with their doctors, that the benefits of retaining their current medication outweigh risk. It's important for women with ADHD who are thinking of breastfeeding to seek a specialist psychiatrist's guidance prior to becoming pregnant. They should discuss their medication with their physician and discuss the advantages and disadvantages of continued treatment, including non-pharmacological strategies. Psychoeducation is also required to help pregnant people with ADHD understand their symptoms and the root cause and learn about treatment options and reinforce existing coping strategies. This should be a multidisciplinary process together with obstetricians, GPs and psychiatry. Pregnancy counseling should include discussion of a treatment plan for the mother as well as the child, and monitoring for signs of deterioration, and, if necessary modifications to the medication regime.