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ADHD Medication During Pregnancy and Breastfeeding Women with ADHD have to make a difficult choice regarding whether or not to stop taking ADHD medication during pregnancy and breastfeeding. There is a lack of information about how long-term exposure to these medications can affect the fetus. A recent study published in Molecular Psychiatry demonstrates that children exposed to ADHD medication during pregnancy do not develop neurological issues such as impaired hearing or vision, febrile seizures, or IQ impairment. The authors acknowledge the need for more high-quality research. Risk/Benefit Analysis Women who are pregnant and taking ADHD medications need to balance the benefits of taking them against the potential risks to the foetus. Doctors don't have the data needed to provide clear recommendations, but they can provide information regarding the risks and benefits to assist pregnant women in making informed decisions. A study published in Molecular Psychiatry concluded that women who took ADHD medication during early pregnancy were not at a greater risk of fetal malformations or structural birth defects. Researchers conducted a massive sample-based case control study to compare the incidence of structural defects that were major in infants born to mothers who used stimulants during pregnancy. Pediatric cardiologists, clinical geneticists and other experts examined the cases to confirm that the classification was accurate and to reduce any bias. The research conducted by the researchers had some limitations. The most important issue was that they were not able to differentiate the effects of the medication from those of the underlying disorder. This limitation makes it difficult to know whether the small differences observed in the groups that were exposed are due to the use of medication or the confounding effect of comorbidities. Researchers also did not look at long-term outcomes for the offspring. The study did reveal that babies whose mothers had taken ADHD medication during pregnancy were at a greater risk of being admitted to the neonatal intensive care unit (NICU) than those whose mothers had not taken any medication or taken off their medication prior to or during pregnancy. This was due to central nervous system disorders, and the increased risk for admission was not found to be influenced by which stimulant medication was used during pregnancy. Women who used stimulant ADHD medication during pregnancy were also at an increased risk of having a caesarean delivery or having a baby with a low Apgar score (less than 7). These increases did not appear to be affected by the type of medication that was used during pregnancy. Researchers suggest that the minor risks associated with the use ADHD medication during pregnancies in the early stages may be offset by the more beneficial outcomes for both baby and mother of continued treatment for the woman's condition. Physicians should discuss the issue with their patients and, when possible, assist them in developing strategies for improving their coping skills that may minimize the negative impact of her condition on her daily life and relationships. Medication Interactions Many doctors are confronted with the dilemma of whether to maintain treatment or stop during pregnancy as more women are diagnosed with ADHD. Often, these decisions are made in the absence of clear and authoritative evidence in either case, which means that doctors must weigh what they know from their own experiences, those of other doctors, and what the research says on the topic and their own best judgment for each patient. The issue of risk to infants is particularly tricky. The research on this subject is based on observation rather than controlled studies, and the results are contradictory. The majority of studies restrict their analysis to live-births, which could underestimate the severity of teratogenic effects which can cause terminations or abortions of pregnancy. The study discussed in this journal club addresses these issues by looking at data from both live and deceased births. Conclusion: While some studies have shown a positive correlation between ADHD medications and certain birth defects however, other studies haven't found a correlation. Most studies have shown an unintended, or slight negative effect. In all cases it is imperative to conduct a thorough study of the risks and benefits is required. For women suffering from ADHD, the decision to stop taking medication is difficult, if not impossible. In a recent article in the 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. In addition, a decrease in medication may affect the ability to do jobs and drive safely, which are important aspects of a normal life for many people with ADHD. She suggests that women who are unsure about whether to keep or stop taking medication because of their pregnancy, consider the possibility of educating friends, family members and colleagues on the condition, its impact on daily life, 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. It is also worth noting that some medications are able to pass 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 medication could be passed on to the baby. Risk of Birth Defects As the use and abuse of ADHD medication to treat symptoms of attention deficit disorder hyperactivity disorder (ADHD) increases as does the concern about the potential adverse effects of the drugs on fetuses. Recent research published in the journal Molecular Psychiatry has added to the body knowledge on this issue. With two massive data sets researchers were able analyze more than 4.3 million pregnancies to determine whether stimulant medications increased the risk of birth defects. Researchers discovered that although the overall risk is low, first-trimester ADHD medication use was associated with slightly higher risk of certain heart defects, like ventriculoseptal defects. The researchers of the study didn't discover any connection between the use of early medications and other congenital anomalies, like facial deformities or club feet. The findings are in line with previous studies revealing the presence of a small, but significant increase in the risk of heart malformations among women who started taking ADHD medications prior to the birth of their child. This risk increased during the latter part of pregnancy, when many women are forced to stop taking their ADHD medication. Women who were taking ADHD medication in the first trimester were more likely need a caesarean or have a low Apgar after birth and have a baby that needed breathing assistance at birth. The researchers of the study were not able to remove bias in selection since they limited their study to women who did not have any other medical conditions that might have contributed to the findings. Researchers hope their research will help doctors when they meet pregnant women. The researchers recommend that, while discussing benefits and risks are important, the decision regarding whether or not to stop medication should be made according to the severity of each woman's ADHD symptoms and her requirements. how to treat adhd without medication in adults advise that, while stopping the medication is an option, it isn't an option that is recommended due to the high prevalence of depression and other mental health issues in women who are pregnant or postpartum. Further, the research suggests that women who decide to stop taking their medications are more likely to have a difficult time getting used to life without them following the birth of their baby. Nursing The responsibilities that come with being a new mom can be overwhelming. Women who suffer from ADHD who must work through their symptoms while attending physician appointments and getting ready for the arrival of a baby and adapting to new routines in the home can experience severe challenges. As such, many women choose to continue taking their ADHD medications throughout pregnancy. The risk to a breastfeeding infant is not too high since the majority of stimulant medications passes through breast milk at a low level. However, the amount of exposure to medication by the infant can differ based on dosage, frequency it is administered and the time of day the medication is administered. Additionally, individual medications enter the baby's system differently through the gastrointestinal tract and breast milk. The impact of this on a newborn is not well known. Some doctors may stop taking stimulant medication during a woman’s pregnancy due to the lack of research. This is a complicated decision for the patient, who must weigh the benefits of continuing her medication against the possible dangers to the fetus. In the meantime, until more information is available, doctors should ask all pregnant patients about their history of ADHD and if they are planning or taking to take medication during the perinatal time. Numerous studies have demonstrated that women can continue to take their ADHD medication in a safe manner during pregnancy and breast-feeding. This has led to many patients opt to do this and, after consulting with their doctor, they have discovered that the benefits of keeping their current medication far exceed any risk. It is essential for women with ADHD who are contemplating breastfeeding to seek out a specialist psychiatrist's advice prior becoming pregnant. They should discuss their medication with their doctor as well as the pros and cons of continuing treatment. This includes non-pharmacological methods. Psychoeducation is also required to help women with ADHD understand their symptoms and the root cause and learn about treatment options and strengthen existing strategies for managing. This should be a multidisciplinary approach including obstetricians, GPs, and psychiatrists. Counselling for pregnancy should include the discussion of a treatment plan for both mother and child, and monitoring for signs of deterioration, and when necessary, making adjustments to the medication regimen.