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ADHD Medication During Pregnancy and Breastfeeding Women with ADHD must make a difficult decision about whether to continue or stop taking ADHD medication during pregnancy and breast-feeding. There aren't enough data regarding how exposure over time 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 loss or impaired vision, febrile seizures, or IQ impairment. The authors acknowledge that more high quality studies are needed. Risk/Benefit Analysis Women who are pregnant and take ADHD medication need to consider the benefits of taking it against the potential risks to the baby. Physicians don't have the data to provide clear recommendations but they can provide information about risks and benefits to assist pregnant women to make informed decisions. A study published in Molecular Psychiatry found that women who were taking ADHD medications during early pregnancy did not have a significantly increased risk of fetal heart malformations or major structural birth defects. Researchers used a vast population-based case-control study to determine the prevalence of major structural birth defects in babies born to mothers who took stimulants during the early stages of pregnancy, as well as those who had not. Clinical geneticists, pediatric cardiologists and other experts reviewed the cases in order to ensure that the classification was correct and to reduce any bias. The study of the researchers was not without limitations. The researchers were not able in the beginning to distinguish the effects of the medication from the disorder. This makes it difficult to know whether the small associations observed in the groups that were exposed are due to the use of medication or confounding by comorbidities. In addition, the researchers did not examine long-term offspring outcomes. The study showed that infants whose mother had taken ADHD medication during pregnancy had a slightly greater risk of being admitted to the neonatal care unit (NICU) in comparison to those whose mothers did not use any medication during pregnancy or 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 medications used during pregnancy. Women who took stimulant ADHD medication during pregnancy also had an increased risk of having a caesarean section or having a baby born with an low Apgar score (less than 7). These increases did appear to be independent of the type of medication used during pregnancy. Researchers suggest that the small risks associated with the use ADHD medication during pregnancies in the early stages may be offset by the greater benefits to both mother and baby of continuing treatment for the woman’s disorder. Physicians should speak with their patients about this issue and as much as possible, assist them improve coping skills which can lessen the impact of her disorder in her daily life 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 a question that doctors are having to have to face. The majority of these decisions are made in the absence of clear and authoritative evidence in either case, which means that doctors must weigh what they know, the experiences of other doctors, and what research says on the topic as well as their own best judgment for each patient. Particularly, the subject of potential risks to the baby can be a challenge. The research on this issue is based on observation instead of controlled studies and a lot of the results are in conflict. The majority of studies restrict their analysis to live births, which may underestimate the teratogenic impact that can lead to terminations or abortions of pregnancy. The study that is discussed in this journal club addresses these issues by analyzing data on live and deceased births. Conclusion A few studies have found an association between ADHD medications and certain birth defects however, other studies haven't shown such a relationship. The majority of studies show a neutral, or even slightly negative, effect. In the end, a careful risk/benefit analysis must be conducted in every instance. For a lot of women with ADHD and ADD, the decision to stop taking medication is difficult if not impossible. 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 these patients. Additionally, the loss of medication can affect the ability to perform job-related tasks and drive safely which are essential aspects of a normal life for many people with ADHD. She suggests that women who are unsure whether to take the medication or discontinue it due to pregnancy educate family members, coworkers and acquaintances about the condition, the effects on daily functioning, and the advantages of staying on the current treatment. Educating them can also help the woman feel supported as she struggles with her decision. It is important to remember that certain medications can pass through the placenta so if the patient decides to stop her ADHD medication during pregnancy and breastfeeding, she must be aware that traces of the drug could be transferred to the infant. Birth Defects and Risk of As the use of ADHD drugs to treat symptoms of attention deficit hyperactivity disorder (ADHD) grows as do concerns about the effects that the drugs could have on fetuses. Recent research published in the journal Molecular Psychiatry has added to the body of knowledge regarding this topic. Researchers utilized two massive datasets to analyze over 4.3 million pregnant women and determine whether stimulant medications increased the risk of birth defects. While the overall risk remains low, the researchers did find that first-trimester exposure to ADHD medications was associated with an increase in the risk of certain heart defects, such as ventriculo-septal defect (VSD). The researchers of the study did not discover any connection between early medication usage and congenital anomalies like facial deformities or club feet. The results are in line with previous studies that have shown an increase, but not significant, in the risk of heart malformations among women who started taking ADHD medications before pregnancy. The risk was higher in the later part of pregnancy, as many women are forced to stop taking their ADHD medications. Women who took ADHD medication in the first trimester were more likely need a caesarean and also have an insufficient Apgar after birth and had a baby that required breathing assistance when they were born. However, the authors of the study were not able to eliminate bias due to selection by limiting the study to women who did not have other medical issues that could have contributed to the findings. The researchers hope that their research will serve to inform the clinical decisions of doctors who encounter pregnant women. They suggest that although the discussion of risks and benefits is important but the decision to stop or keep treatment should be based on each woman's needs and the severity of her ADHD symptoms. The authors also warn that even though stopping the medication is an option, it isn't an option that is recommended due to the high incidence of depression and other mental health issues for women who are expecting or post-partum. Research has also shown that women who stop taking their medications will have a tough time adjusting to a life without them once the baby is born. Nursing It can be overwhelming to become a mom. Women who suffer from ADHD can face severe challenges when they must deal with their symptoms, go to doctor appointments and prepare for the birth of a child and adjust to new routines. Many women opt to continue taking their ADHD medication during pregnancy. The majority of stimulant medicines pass through breast milk in small amounts, therefore the risk to breastfeeding infant is minimal. However, the rate of exposure to medication by the infant can differ based on dosage, frequency it is taken and the time of the day the medication is administered. Additionally, different drugs enter the infant's system through the gastrointestinal tract, or through breast milk. The impact of these medications on the health of a newborn is not completely known. adhd without medication may stop taking stimulant medication during a woman's pregnancy due to the absence of research. It's a difficult choice for the woman, who must weigh the advantages of taking her medication as well as the risk to the embryo. As long as there is no more information, doctors should inquire with all pregnant patients about their experience with ADHD and if they are taking or planning to take medication during the perinatal time. Numerous studies have proven that women can continue taking their ADHD medication without risk during pregnancy and breast-feeding. In response, an increasing number of patients are choosing to do this. They have concluded through consultation with their physicians that the benefits of continuing their current medication outweigh any risk. It is crucial for women suffering from ADHD who are contemplating breastfeeding to seek a specialist psychiatrist's guidance prior to becoming pregnant. They should discuss the medication they are taking with their physician, and the pros and cons of continuing treatment. This includes non-pharmacological methods. Psychoeducation is also required to help pregnant women suffering from ADHD recognize the signs and underlying disorder. They should also be educated about treatment options and strengthen strategies for coping. This should be an approach that is multidisciplinary, including the GP as well as obstetricians, psychiatry and obstetricians. Counselling for pregnancy should include the discussion of a treatment plan for both the mother and child, as well as monitoring for signs of deterioration and the need for adjustments to the medication regimen.