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ADHD Medication During Pregnancy and Breastfeeding Women suffering from ADHD must make a difficult decision on whether to keep or stop taking ADHD medication during pregnancy and breast-feeding. Little data exists about how long-term exposure to these drugs can affect the fetus. A recent study published in Molecular Psychiatry shows that children exposed to ADHD medication in utero do not develop neurological disorders such as hearing loss or impaired vision seizures, febrile seizures, or IQ impairment. The authors acknowledge that more high quality studies are required. Risk/Benefit Analysis Women who are expecting and taking ADHD medication need to weigh the benefits of taking it against the possible dangers for the fetus. Physicians do not have the information needed to give clear guidelines, but they can provide information regarding risks and benefits that aid pregnant women in making informed choices. A study published in Molecular Psychiatry found that women who took ADHD medications in early pregnancy did not face a significantly increased risk of fetal cardiac malformations or major birth defects that are structural. Researchers conducted a large population-based study of case-control to assess the risk of major structural birth defects in infants born to mothers who had taken stimulants in early pregnancy, and those who did not. Clinical geneticists, pediatric cardiologists and other experts looked over the cases to confirm that the classification was correct and to minimize any bias. The research conducted by the researchers was not without its limitations. In particular, they were unable to separate the effects of the medication from the disorder at hand. This makes it difficult to determine whether the small differences observed in the exposed groups are due to medication use or comorbidities that cause confusion. The researchers also did not look at long-term outcomes for the offspring. The study revealed 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 mothers who did not take 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 affected by the stimulant medication used during pregnancy. Women who were taking stimulant ADHD medication during pregnancy were also at an elevated risk of having a caesarean section or having a baby born with low Apgar score (less than 7). These increases didn't appear to be influenced by the kind of medication used during pregnancy. The research suggests that the low risk associated with the use of ADHD medications during the early stages of pregnancy may be offset by the higher benefit to both the mother and child of continuing treatment for the woman's condition. Physicians should discuss the issue with their patients and, when they are able, assist them in developing strategies for improving their coping skills which can reduce the impact of her disorder on her daily functioning and relationships. Interactions with Medication More and more doctors are faced with the decision of whether to continue treatment or stop as more women are diagnosed with ADHD. These decisions are usually made without clear and reliable evidence. Instead, doctors have to consider their own expertise and experience, as well as the experiences of other doctors and the research that has been conducted on the subject. The issue of possible risks for infants can be extremely difficult. The research on this subject is based on observations rather than controlled studies and the results are in conflict. The majority of studies focus on live births, which may underestimate the severity of teratogenic effects which can cause abortions or terminations of pregnancy. The study discussed in this journal club addresses these shortcomings by analyzing data on live and deceased births. Conclusion A few studies have shown an association between ADHD medications and certain birth defects however, other studies haven't shown such a relationship. Most studies have shown that there is a neutral, or slight negative impact. In the end, a careful risk/benefit analysis is required in every case. It can be difficult, if not impossible, for women suffering from ADHD to stop taking their medication. In fact, in an article published in Archives of Women's Mental Health, psychologist Jennifer Russell notes that stopping ADHD medication during pregnancy can increase depression, feelings of isolation, and family conflict for these patients. A decrease in medication could also affect the ability to drive safely and to perform work-related tasks which are crucial aspects of everyday life for those suffering from ADHD. She recommends that women who are unsure about whether or not to stop medication in light of their pregnancy should consider informing family members, friends and colleagues about the condition, its impact on daily life, and the advantages of continuing the current treatment plan. Educating them can also aid in ensuring that the woman feels supported as she struggles with her decision. Some medications can pass through the placenta. If a woman decides not to take her ADHD medication while pregnant and breastfeeding, it's important to be aware that the medication could be transferred to the infant. Birth Defects Risk As the use and abuse of ADHD medication to treat symptoms of attention deficit hyperactivity disorder (ADHD) increases as does the concern about the potential effects of these drugs on the fetuses. Recent research published in the journal Molecular Psychiatry has added to the body of knowledge regarding this issue. Utilizing two huge data sets researchers were able to analyze more than 4.3 million pregnancies to determine whether stimulant medication use increased the risk of birth defects. While the overall risk remains low, the researchers did find that first-trimester exposure to ADHD medicines was associated with an increased risk of specific heart defects, like ventriculo-septal defects (VSD). The authors of the study didn't discover any link between early use of medication and other congenital anomalies such as facial deformities or club feet. The results are in the same vein as previous studies that have shown the existence of a slight, but significant increase in the number of cardiac malformations among women who began taking ADHD medication prior to the birth of their child. The risk was higher in the latter half of pregnancy, when many women decide to stop taking their medication. Women who took ADHD medication during the first trimester were more likely need a caesarean, have a low Apgar after delivery and have a baby that needed breathing assistance at birth. However the authors of the study were not able to eliminate selection bias by restricting the study to women who did not have any other medical conditions that could be a contributing factor to these findings. Researchers hope their research will inform physicians when they encounter pregnant women. medications for adhd in adults recommend that, while a discussion of the risks and benefits is crucial, the decision to stop or continue treatment should be based on the woman's needs and the severity of her ADHD symptoms. The authors also advise that even though stopping the medication is an option, it isn't an option to consider due to the high prevalence of depression and other mental health problems in women who are pregnant or postpartum. Research has also shown that women who stop taking their medications will have a harder adjustment to life without them after the baby is born. Nursing It can be overwhelming to become a mom. Women who suffer from ADHD who have to manage their symptoms while attending doctor appointments, getting ready for the arrival of their child and adapting to new routines in the home can experience severe challenges. Therefore, many women decide to continue taking their ADHD medications throughout the course of pregnancy. The majority of stimulant medicines pass through breast milk in low quantities, so the risk to the breastfeeding infant is minimal. The rate of exposure to medication will differ based on dosage, frequency of administration and time of day. Additionally, different medications are introduced into the baby's system through the gastrointestinal tract or through breast milk. The effect on the health of a newborn isn't completely comprehended. Some doctors may decide to stop stimulant medication during a woman’s pregnancy due to the absence of research. This is a difficult choice for the patient, who must weigh the benefit of continuing her medication against the potential dangers to the fetus. In the meantime, until more information is available, doctors should inquire with all pregnant patients about their history of ADHD and whether they are taking or planning to take medication during the perinatal time. A increasing number of studies have revealed that the majority of women are able to safely continue taking their ADHD medication while they are pregnant and nursing. This has led to an increasing number of patients choose to do so and, in consultation with their physician, they have found that the benefits of maintaining their current medication exceed any risk. Women with ADHD who plan to breastfeed should seek advice from a specialist psychiatrist before becoming pregnant. They should discuss their medication with their prescriber and discuss the pros and cons for continuing treatment. medication for adult add includes non-pharmacological methods. Psychoeducation is also needed to help pregnant women with ADHD be aware of the symptoms and underlying disorder. They should also learn about treatment options and reinforce strategies for coping. This should include a multidisciplinary approach with the GP as well as obstetricians, psychiatry and obstetricians. Pregnancy counseling should include a discussion of a treatment plan for the mother as well as the child, monitoring of indicators of deterioration, and, if necessary modifications to the medication regimen.