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ADHD Medication During Pregnancy and Breastfeeding The decision to stop or continue ADHD medication during pregnancy and nursing is a difficult decision for women suffering from the condition. Little data exists about how long-term exposure to these drugs can affect the fetus. A study recently published in Molecular Psychiatry demonstrates that children exposed to ADHD medication during pregnancy do not develop neurological problems such as hearing loss or vision, febrile seizures or IQ impairment. The authors acknowledge the need for more high-quality research. Risk/Benefit Analysis Pregnant women who use ADHD medications must weigh the advantages of using them against the risks to the foetus. Doctors don't have enough data to give clear advice but they can provide information on the risks and benefits to aid pregnant women in making an informed decision. A study published in Molecular Psychiatry concluded that women who took ADHD medication during early pregnancy did not have a higher risk of fetal malformations or structural birth defects. Researchers conducted a large population-based case control study to compare the incidence of major structural defects in infants who were born to mothers who used stimulants during pregnancy. Pediatric cardiologists, clinical geneticists and other experts looked over the cases to ensure that the classification was accurate and to eliminate any bias. The study of the researchers had some limitations. The most important issue was that they were unable to distinguish the effects of the medication from the disorder that is underlying. This makes it difficult for researchers to establish whether the few associations observed between the groups exposed were due to the use of medication or if they were caused by comorbidities. In addition the researchers did not look at long-term offspring outcomes. The study found that infants whose mother had taken ADHD medication during pregnancy were at a slightly greater risk of being admitted to the neonatal care unit (NICU) as compared to those whose mothers did not take any medication during pregnancy, or had quit taking the medication prior to or during pregnancy. The reason for this was central nervous system disorders, and the increased risk for admission did not appear to be influenced by which stimulant medication was used during pregnancy. Women who used stimulant ADHD medication during pregnancy were also at an elevated risk of having a caesarean birth or having a child with an low Apgar score (less than 7). These risks did not seem to be influenced by the kind of medication used during pregnancy. Researchers suggest that the small risks associated with the use ADHD medication during pregnancies in the early stages can be offset by more beneficial outcomes for both mother and baby from continuing treatment for the woman's condition. Physicians should discuss the issue with their patients and, if possible, help them develop strategies to improve coping skills which can reduce the impact of her disorder on her daily functioning and relationships. Medication Interactions As more women than ever are diagnosed with ADHD and being treated with medication, the issue of whether or not to end treatment during pregnancy is one that more and more physicians face. These decisions are frequently made without clear and reliable evidence. Instead, physicians must consider their own expertise and experience, as well as the experiences of other doctors and the research on the subject. The issue of potential risks to the infant can be particularly tricky. Many of the studies on this subject are based on observations instead of controlled research and their findings are often contradictory. Most studies limit their analysis to live-births, which could underestimate the teratogenic impact which can cause abortions or terminations of pregnancy. The study discussed in the journal club addresses these limitations by analyzing both information on deceased and live births. The conclusion is that while some studies have shown a positive association between ADHD medications and the possibility of certain birth defects, other studies have found no connection and the majority of studies demonstrate a neutral or slightly negative effect. As a result, a careful risk/benefit analysis must be conducted in every situation. It can be challenging, if not impossible, for women suffering from ADHD to stop taking their medication. In a recent article in Archives of Women's Mental Health by psychologist Jennifer Russell, she notes that stopping ADHD medications during pregnancy can lead to depression and feelings of being isolated. Furthermore, a loss of medication can affect the ability to complete 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 continue or stop taking medication because of their pregnancy consider educating family members, friends, and coworkers on the condition, its effects on daily life, and the benefits of keeping the current treatment regimen. Educating them can also make the woman feel more comfortable when she is struggling with her decision. It is important to remember that certain medications can be absorbed through the placenta so if the patient decides to stop her ADHD medication during pregnancy and breastfeeding, she should be aware that traces of the drug can be transferred to the child. Birth Defects and Risk of As the use and abuse of ADHD medications to treat the symptoms of attention deficit hyperactivity disorder (ADHD) is increasing as does the concern about the potential effects of these drugs on foetuses. A study that was published in the journal Molecular Psychiatry adds to the existing knowledge about this subject. adhd depression medication utilized two massive datasets to analyze over 4.3 million pregnancy and determine if stimulant medication use increased birth defects. While the overall risk remains low, the researchers discovered that the first-trimester exposure to ADHD medicines was associated with an increased risk of certain heart defects, such as ventriculo-septal defect (VSD). The researchers behind the study found no connection between early use of medication and congenital abnormalities like facial clefting, or club foot. The findings are in line with previous studies that have shown the presence of a small, but significant increase in the risk of cardiac malformations among women who began taking ADHD medications prior to the time of pregnancy. The risk was higher during the latter part of pregnancy, as many women begin to discontinue their ADHD medication. Women who used ADHD medication in the first trimester of pregnancy were also more likely to have caesarean section, low Apgar score after delivery and a baby who required breathing assistance during birth. However the authors of the study were not able to eliminate selection bias by limiting the study to women who did not have any other medical conditions that could have contributed to the findings. The researchers hope that their research will aid in the clinical decisions of doctors who treat pregnant women. The researchers advise that, while discussing risks and benefits are crucial, the decision regarding whether or not to stop 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 a possibility to consider, it is not recommended due to the high prevalence of depression and other mental problems for women who are pregnant or have recently given birth. 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 baby's arrival. Nursing The responsibilities of being a new mother can be overwhelming. Women who suffer from ADHD who must work through their symptoms while attending physician appointments and making preparations for the arrival of their child and adapting to new routines in the home are often faced with a number of difficulties. This is why many women decide to continue taking their ADHD medications throughout the course of pregnancy. The risk to nursing infant is low because the majority of stimulant medication passes through breast milk in low amounts. However, the amount of medication exposure to the newborn may differ based on dosage, frequency it is administered, and the time of the day the medication is administered. Additionally, different medications enter the baby’s system through the gastrointestinal tract or breast milk. The impact on the health of a newborn is not completely understood. Some doctors may stop taking stimulant medication during a woman’s pregnancy due to the absence of research. This is a complicated decision for the patient, who must balance the benefits of continuing her medication with the potential risks to the foetus. In the meantime, until more information is available, GPs can ask pregnant patients if they have any history of ADHD or if they are planning to take medication during the perinatal phase. A growing number of studies have revealed that the majority of women are able to safely continue their ADHD medication while they are pregnant and nursing. In the end, many patients are choosing to do so and in consultation with their physician, they have discovered that the benefits of maintaining their current medication far exceed any risk. Women who suffer from ADHD who are planning to breastfeed should seek advice from a specialist psychiatrist before becoming pregnant. They should discuss the medication they are taking with their physician and discuss the pros and cons of continuing treatment. This includes non-pharmacological methods. Psychoeducation should also be offered to help women with ADHD be aware of their symptoms and the root cause, learn about available treatment options and reinforce existing strategies for managing. This should include a multidisciplinary approach with the GP doctors, obstetricians and psychiatrists. The pregnancy counselling should consist of the discussion of a plan for management for both mother and child, monitoring for signs of deterioration, and the need for adjustments to the medication regimen.