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ADHD Medication During Pregnancy and Breastfeeding Women with ADHD face a difficult decision on whether to keep or stop taking ADHD medication during pregnancy and breastfeeding. There is a lack of information about how long-term exposure to these medications may affect the foetus. A study recently published in Molecular Psychiatry shows that children exposed to ADHD medication in the uterus do not develop neurological disorders like hearing loss or impaired vision, febrile seizures, or IQ impairment. The authors acknowledge that more high-quality research is needed. Risk/Benefit Analysis Women who are pregnant and taking ADHD medications need to balance the benefits of taking them against potential risks to the fetus. The doctors don't have the information to provide clear recommendations but they can provide information on the risks and benefits to assist pregnant women to make informed decisions. add medication uk published in Molecular Psychiatry found that women who took ADHD medications during their early pregnancy did not have an increased risk of fetal heart malformations or major birth defects that are structural. Researchers conducted a massive population-based case control study to assess the frequency of major structural defects in infants born to mothers who used stimulants during pregnancy. Pediatric cardiologists, clinical geneticists and other experts reviewed the cases in order to make sure that the classification was correct and to eliminate any bias. However, the study had its limitations. Researchers were unable, in the first place, to separate the effects of the medication from the disorder. This makes it difficult for researchers to establish whether the few associations observed between the exposed groups were due to the use of medications, or if they were affected by comorbidities. Additionally the researchers did not study the long-term effects of offspring on their parents. 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) in comparison to mothers who didn't take any medication during pregnancy or quit taking the medication prior to or during pregnancy. This was due to central nervous system disorders. The higher risk of admission was not affected by the stimulant medications used during pregnancy. Women who took stimulant ADHD medications during pregnancy also had a higher chance of having an emergency caesarean section or having the baby was not scoring well on the Apgar scale (less than 7). These increases did appear to be independent of the type of medication taken during pregnancy. The research suggests that the low risk associated with the use of ADHD medications during early pregnancy could be offset by the higher benefit to both mother and child of continued treatment for the woman's condition. Doctors should discuss with their patients about this and, if possible, help them improve coping skills which can lessen the effects of her disorder on her daily functioning and her relationships. Medication Interactions 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 often made without clear and reliable evidence. Instead, doctors have to consider their own expertise, the experience of other physicians and the research on the subject. Particularly, the issue of possible risks to the infant can be difficult. The research on this subject is based on observations 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 which can cause abortions or terminations of pregnancy. The study presented in this journal club addresses these limitations by analyzing data on live and deceased births. The conclusion is that while some studies have shown an association between ADHD medications and the possibility of certain birth defects, others have found no connection and the majority of studies demonstrate a neutral or slightly negative effect. In every case it is imperative to conduct a thorough study of the potential risks and benefits must be performed. It can be challenging, if not impossible for women suffering from ADHD to stop taking their medication. In an article published in Archives of Women's Mental Health psychologist Jennifer Russell notes that stopping ADHD medication during pregnancy can cause depression, feelings of loneliness, and family conflict for these patients. A loss of medication may affect the ability to drive safely and perform work-related tasks, which are essential aspects of normal life for those suffering from ADHD. She suggests that women who are unsure about whether or not to discontinue medication due to their pregnancy consider the possibility of educating friends, family members and colleagues about the condition, its impact on daily functioning, and the benefits of keeping the current treatment regimen. It will also help a woman feel supported in her decision. It is also worth noting that some medications are able to be absorbed through the placenta so if a woman decides to stop her ADHD medication during pregnancy and breastfeeding, she must be aware that the effects of the drug could be transferred to the child. Birth Defects and Risk of As the use of ADHD drugs to treat symptoms of attention deficit hyperactivity disorder (ADHD) increases there are concerns about the effects that the medications could have on foetuses. A recent study published in the journal Molecular Psychiatry adds to the existing information on this topic. Researchers used two huge data sets to study more than 4.3 million pregnant women and determine if stimulant medication use increased the risk of birth defects. Although the risk overall remains low, the researchers found that exposure in the first trimester to ADHD medicines was associated with an increase in the risk of specific heart defects, such as ventriculoseptal defect (VSD). The authors of the study found no association between the use of early medications and other congenital anomalies, such as facial clefting or club foot. The results are in line with previous studies that showed a small, but significant increase in cardiac malformations for women who began taking ADHD medication before the time of pregnancy. The risk increased in the latter part of pregnancy when a large number of women began to stop taking their medication. Women who took ADHD medications during the first trimester of their pregnancies were also more likely to undergo caesarean sections, a low Apgar score after delivery and a baby that required breathing assistance during birth. The researchers of the study were unable to eliminate selection bias because they limited their study to women without other medical conditions that could have contributed to the findings. Researchers hope their research will provide doctors with information when they encounter pregnant women. They advise that while the discussion of risks and benefits is important but the decision to stop or maintain treatment should be based on each woman's requirements and the severity of her ADHD symptoms. The authors warn that, although stopping the medication is an option to consider, it is not advised due to the high prevalence of depression and mental health issues among women who are pregnant or who have recently given birth. Further, the research suggests that women who decide to stop their medications are more likely to experience difficulties getting used to life without them following the baby's arrival. Nursing It can be a stressful experience becoming a mother. Women with ADHD who must work through their symptoms while attending physician appointments and getting ready for the arrival of their child and adjusting to new household routines can experience severe challenges. This is why many women elect to continue taking their ADHD medication throughout the pregnancy. The risk to a breastfeeding infant is not too high since the majority of stimulant medication passes through breast milk in low amounts. However, the frequency of exposure to medication by the newborn can vary depending on dosage, frequency it is taken and the time of day it is administered. Additionally, different medications are introduced into the baby's system through the gastrointestinal tract, or through breast milk. The impact of these medications on a newborn's health is not fully comprehended. Because of the lack of research, some doctors may be inclined to discontinue stimulant medications during the course of pregnancy. This is a complicated decision for the patient, who must weigh the benefits of keeping her medication against the potential dangers to the fetus. Until more information is available, doctors should ask all pregnant patients about their history of ADHD and if they plan or are taking to take medication during the perinatal period. Many studies have shown that women can continue taking their ADHD medication without risk during pregnancy and while breast-feeding. This has led to many patients choose to do so, and in consultation with their physician, they have discovered that the benefits of continuing their current medication exceed any risk. It is essential for women with ADHD who are thinking of breastfeeding to seek a specialist psychiatrist's advice prior to becoming pregnant. They should review their medications with their physician and discuss the advantages and disadvantages of continuing treatment, including non-pharmacological strategies. Psychoeducation is also needed to help pregnant women suffering from ADHD recognize the signs and the underlying disorder. They should also be informed about treatment options and reinforce the coping mechanisms. 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, as well as monitoring for signs of deterioration and the need for adjustments to the medication regimen.