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ADHD Medication During Pregnancy and Breastfeeding Women suffering from ADHD must make a difficult decision regarding whether or not to stop taking ADHD medication during pregnancy and breast-feeding. There are few data regarding how exposure over time may affect a fetus. A study recently published in Molecular Psychiatry demonstrates that children exposed to ADHD medication during pregnancy do not develop neurological problems such as impaired hearing or vision, febrile seizures, or IQ impairment. The authors acknowledge that more high quality research is needed. Risk/Benefit Analysis Women who are pregnant and taking ADHD medication must evaluate the benefits of using it against the potential dangers for the foetus. Doctors don't have enough data to make unambiguous recommendations but they can provide information on the risks and benefits to assist pregnant women to make an informed decision. A study published in Molecular Psychiatry found that women who were taking ADHD medications in early pregnancy did not have a significantly higher risk of fetal cardiac malformations or major structural birth defects. The researchers used a large, population-based case-control study to assess the risk of major structural birth defects in babies born to mothers who had taken stimulants during the early stages of pregnancy, as well as those who had not. Clinical geneticists, pediatric cardiologists and other experts examined the cases to confirm that the classification was correct and to eliminate any bias. However, the researchers' study had its limitations. Researchers were unable in the beginning, to separate the effects of the medication from the disorder. This limitation makes it difficult for researchers to determine whether the small associations observed among the groups exposed were due to the use of medications or if they were affected by comorbidities. In addition, the researchers did not study the long-term effects of offspring on their parents. The study did find that infants whose mothers took ADHD medications during pregnancy were at a slightly higher risk of being admitted to the neonatal intensive care unit (NICU) than those whose mothers had not taken any medication or had cut back on their medications prior to or during pregnancy. This was due to central nervous system-related disorders and the increased risk of admission was not found to be influenced by the stimulant medication was used during pregnancy. Women who took stimulant ADHD medications during pregnancy also had a higher risk of having to have a caesarean section or a baby that scored low on the Apgar scale (less than 7). These increases didn't appear to be affected by the kind of medication used during pregnancy. The research suggests that the small risk associated with the use of ADHD medications during early pregnancy could be offset by the greater benefits for both mother and child from continued treatment for the woman's disorder. adult add medications should discuss the issue with their patients and, if possible, assist them in developing strategies to improve their coping abilities that may minimize the effects of her disorder on her daily life and relationships. Medication Interactions As more women than ever are being diagnosed with ADHD and being treated with medication, the issue of whether to keep or end treatment during pregnancy is a question that more and more physicians have to face. The majority of these decisions are made in the absence of any evidence that is clear and definitive regardless, so doctors have to weigh their experience from their own experiences, those of other doctors, and what the research says on the topic, along with their best judgment for each patient. Particularly, the subject of possible risks to the baby can be a challenge. The research that has been conducted on this topic is based on observation instead of controlled studies and a lot of the results are in conflict. 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 this journal club addresses these issues by examining data on both live and deceased births. Conclusion Some studies have found a positive correlation between ADHD medications and certain birth defects however, other studies haven't shown such a relationship. Most studies show an unintended, or slightly negative, impact. In each case, a careful evaluation of the risks and benefits is required. For women suffering from ADHD and ADD, the decision to discontinue medication is difficult, if not impossible. In a recent article published in 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. Additionally, the loss of medication may affect the ability to complete work-related tasks and safely drive that are crucial aspects of daily life for many people with ADHD. She suggests that women who are unsure whether to continue taking medication or stop due to pregnancy educate family members, coworkers and their friends about the condition, its effects on daily functioning, and the advantages of staying on the current treatment regimen. In addition, educating them can make the woman feel more comfortable when she is struggling with her decision. Certain medications can pass through the placenta. If a woman decides not to take her ADHD medication while pregnant and breastfeeding, it is important to be aware that the medication could be transferred to the infant. Risk of Birth Defects As the use and abuse 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. Recent research published in the journal Molecular Psychiatry has added to the body of knowledge regarding this issue. adult add medication utilized two massive datasets to analyze more than 4.3 million pregnant women and determine whether stimulant medications caused birth defects. Researchers found that while the overall risk is low, the first trimester ADHD medication use was associated with slightly higher rates of specific heart defects like ventriculoseptal defects. The researchers behind the study found no link between early medication use and other congenital abnormalities, like facial clefting, or club foot. The findings are in line with previous studies that have shown an increase, but not significant, in the risk of cardiac malformations among women who started taking ADHD medications prior to the birth of their child. The risk increased in the latter half of pregnancy when a large number of women stopped taking their medication. Women who were taking ADHD medication in the first trimester were more likely require a caesarean birth and also have an insufficient Apgar after delivery and have a baby that needed breathing assistance after birth. The authors of the study were unable to eliminate bias due to selection because they limited the study to women who did not have any other medical conditions that might have contributed to the findings. The researchers hope that their research will serve to inform the clinical decisions of physicians who treat pregnant women. They recommend that, while the discussion of the benefits and risks is important, the decision to stop or maintain treatment should be based on the woman's needs and the severity of her ADHD symptoms. The authors also warn that even though stopping the medication is an alternative, it is not an option that is recommended due to the high prevalence of depression and other mental health issues among women who are pregnant or recently post-partum. Further, the research suggests that women who decide to stop their medications are more likely to have a difficult time getting used to life without them after the birth of their baby. Nursing The responsibilities of being a new mom can be overwhelming. Women who suffer from ADHD can face severe challenges when they must manage their symptoms, go to doctor appointments and prepare for the birth of a baby and adjust to a new routine. Therefore, many women elect to continue taking their ADHD medications throughout the course of 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 exposure to medications by the newborn can vary depending on dosage, frequency it is taken and at what time it is administered. In addition, individual medications enter the body of the baby differently through the gastrointestinal tract and breast milk and the impact of this on a newborn infant is not fully known. Some physicians may discontinue stimulant medication during a woman's pregnancy due to the lack of research. This is a difficult decision for the woman who must weigh the advantages of her medication against the potential risks to the fetus. As long as more information is available, doctors may inquire about pregnant patients if they have an history of ADHD or if they intend to take medication during the perinatal stage. Many studies have shown that women can continue taking their ADHD medication in a safe manner during pregnancy and while breast-feeding. This has led to more and more patients choose to do so, and in consultation with their doctor they have discovered that the benefits of continuing their current medication exceed any risk. It is essential for women with ADHD who are considering breastfeeding to seek out a specialist psychiatrist's guidance prior to becoming pregnant. They should discuss their medication with their prescriber and discuss the pros and cons for continuing treatment. This includes non-pharmacological strategies. Psychoeducation should also be offered to help pregnant people with ADHD recognize their symptoms and the root cause, learn about available treatment options and strengthen existing strategies for managing. This should involve a multidisciplinary approach, which includes the GP as well as obstetricians, psychiatry and obstetricians. Pregnancy counseling should consist of a discussion of a treatment plan for the mother and child, monitoring of signs of deterioration, and, if needed adjustments to the medication regime.