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ADHD Medication During Pregnancy and Breastfeeding The decision to stop or keep ADHD medications during breastfeeding and pregnancy is a difficult decision for women suffering from the condition. There are few data on how long-term exposure may affect the fetus. A study recently published in Molecular Psychiatry shows that children exposed to ADHD medication in the uterus don't develop neurological developmental disorders like hearing or vision impairment seizures, febrile seizures or IQ impairment. The authors acknowledge the need for more high-quality studies. Risk/Benefit Analysis Women who are pregnant and taking ADHD medications need to balance the advantages of using them against the risks to the foetus. Physicians don't have the data to make unambiguous recommendations however they can provide information on risks and benefits to aid pregnant women in making informed decisions. A study published in Molecular Psychiatry concluded that women who took ADHD medication in early pregnancy were not at higher risk of fetal malformations, or structural birth defects. Researchers used a large population-based case control study to examine the prevalence of major structural defects in infants born to mothers who took stimulants during pregnancy. Pediatric cardiologists, clinical geneticists and other experts examined the cases to make sure that the classification was accurate and to minimize any bias. The research conducted by the researchers had some limitations. The researchers were not able in the beginning to distinguish the effects caused by the medication from the disorder. This makes it difficult to determine whether the limited associations observed in the groups that were exposed are due to medication use or comorbidities that cause confusion. Researchers also did not look at long-term outcomes for the offspring. The study found that infants whose mothers took ADHD medication during pregnancy had a slightly higher chance of being admitted to the neonatal care unit (NICU) as compared to those whose mothers did not use any medication during pregnancy, or had quit taking the medication prior to or during pregnancy. This increase was caused by central nervous system disorders. The increased risk of admission was not influenced by the stimulant medication used during pregnancy. Women who took stimulant ADHD medications during pregnancy also had a higher chance of having to have an emergency caesarean section or having the baby was not scoring well on the Apgar scale (less than 7). These risks did not appear to be affected by the type of medication that was used 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 higher benefit to both mother and child of continuing treatment for the woman's disorder. Physicians should discuss the issue with their patients and, if they are able, assist them in developing strategies for improving their coping skills which can reduce the negative impact of her condition on her daily life and relationships. Medication Interactions Doctors are increasingly confronted with the dilemma of whether to maintain treatment or stop as more women are diagnosed with ADHD. These decisions are often made without clear and reliable evidence. Instead, doctors have to weigh their own knowledge, the experience of other physicians and the research on the subject. Particularly, the subject of possible risks to the infant can be difficult. A lot of studies on this issue are based on observations instead of controlled research and their findings are often contradictory. The majority of studies limit their analysis to live births, which can underestimate the severity of teratogenic effects leading to abortions or terminations of pregnancy. The study presented in the journal club addresses these issues, by examining both information on deceased and live births. The conclusion The conclusion: While some studies have found an association between ADHD medications and the possibility of certain birth defects, others have found no connection, and most studies demonstrate a neutral or slight negative effect. Therefore an accurate risk-benefit analysis must be done in each case. For women suffering from ADHD, 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. Furthermore, a loss of medication may affect the ability to do job-related tasks and drive safely, which are important aspects of daily life for many people suffering from ADHD. medication adhd adults iampsychiatry.uk recommends women who are uncertain about whether or not to stop taking medication because of their pregnancy, consider educating family members, friends and colleagues about the condition, its impact on daily functioning, and the benefits of keeping the current treatment plan. It can also help women feel confident about her decision. It is important to note that certain medications can pass through the placenta so if a woman decides to stop her ADHD medication during pregnancy and breastfeeding, she must be aware that traces of the medication could be passed on to the baby. Birth Defects and Risk of As the use of ADHD medications to treat symptoms of attention deficit hyperactivity disorder (ADHD) increases as do concerns about the effects that the medications could have on fetuses. A study that was published in the journal Molecular Psychiatry adds to the existing knowledge on this subject. Researchers utilized two massive datasets to analyze more than 4.3 million pregnant women and determine if stimulant medication use increased the risk of birth defects. Researchers discovered that, while the risk overall is low, first-trimester ADHD medication use was associated with slightly higher risk of certain heart defects, like ventriculoseptal defects. The authors of the study didn't discover any link between early use of medication and congenital anomalies like facial deformities or club feet. The results are in agreement with previous studies which showed the existence of a slight, but significant increase in cardiac malformations for women who began taking ADHD medication before the birth of their child. The risk grew in the later part of pregnancy, when a lot of women begin to discontinue their ADHD medication. Women who used ADHD medications during the first trimester of their pregnancy were also more likely to experience a caesarean section, a low Apgar score following delivery, and a baby who needed breathing assistance during birth. The authors of the study could not eliminate bias due to selection because they restricted the study to women with no other medical conditions that might have contributed to the findings. Researchers hope that their study will provide doctors with information when they meet pregnant women. They advise that while the discussion of risks and benefits is important but the decision to stop or maintain medication should be based on each woman's requirements and the severity of her ADHD symptoms. The authors warn that, while stopping the medication is an option to think about, it isn't recommended due to the high prevalence of depression and other mental problems among women who are pregnant or recently gave birth. Additionally, research suggests that women who stop taking their medications will have a difficult time adjusting to a life without them after the baby is born. Nursing It can be a challenge to become a mom. 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 a child and adjust to a new routine. Many women opt to continue taking their ADHD medication during pregnancy. The majority of stimulant drugs are absorbed by breast milk in small amounts, therefore the risk to breastfeeding infant is minimal. However, the amount of exposure to medication by the newborn can vary depending on dosage, frequency it is administered, and the time of day the medication is administered. Additionally, different drugs enter the infant's system via the gastrointestinal tract or through breast milk. The effect on a newborn's health is not completely known. Due to the absence of research, some physicians may recommend stopping stimulant medications during the course of pregnancy. This is a difficult choice for the patient, who must balance the benefits of keeping her medication with the potential risks to the embryo. Until more information becomes available, doctors may inquire about pregnant patients if they have a background of ADHD or if they intend to take medication during the perinatal period. Numerous studies have demonstrated that women can continue to take their ADHD medication without risk during pregnancy and breast-feeding. This has led to 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. It is essential for women with ADHD who are thinking of breastfeeding to seek out a specialist psychiatrist's advice prior becoming pregnant. They should review their medications with their prescriber and discuss the advantages and disadvantages of continuing treatment, including non-pharmacological strategies. Psychoeducation is also needed to help pregnant women suffering from ADHD understand the symptoms and the underlying disorder. They should also be informed about treatment options and build strategies for coping. This should be a multidisciplinary approach, which includes the GP, obstetricians and psychiatry. Pregnancy counselling should include discussion of a management plan for both the mother as well as the child, as well as monitoring for signs of deterioration and, if necessary, adjustments to the medication regimen.