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ADHD Medication During Pregnancy and Breastfeeding Women suffering from ADHD face a difficult decision on whether to keep or stop taking ADHD medication during pregnancy and breast-feeding. There isn't much information on how long-term exposure to these drugs 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 like hearing loss or vision, febrile seizures or IQ impairment. The authors acknowledge that further high-quality research is needed. Risk/Benefit Analysis Pregnant women who use ADHD medications need to balance the benefits of using them against the risks to the fetus. Physicians don't have the data to give clear advice but they can provide information on risks and benefits to assist pregnant women to make informed decisions. A study published in Molecular Psychiatry found that women who used ADHD medications during their early pregnancy did not have a significantly increased risk of fetal cardiac malformations or major birth defects that are structural. Researchers conducted a massive sample-based case control study to examine the prevalence of structural defects that were major in infants who were born to mothers who used stimulants during pregnancy. Pediatric cardiologists and clinical geneticists examined the cases to ensure an accurate case classification and to limit the possibility of bias. However, the researchers' study had its limitations. The researchers were unable to, in the first place, to separate the effects caused by the medication from the disorder. 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 did not examine the long-term effects for the offspring. The study did find that babies whose mothers had taken ADHD medication during pregnancy were at slightly higher risk of being admitted to the neonatal intensive care unit (NICU) than infants whose mothers had not taken any medication or taken off their medication prior to or during pregnancy. The reason for this was central nervous system-related disorders and the increased risk of admission was not found to be affected by the type of stimulant medication was used during pregnancy. please click the following web site who took stimulant ADHD medications during pregnancy also had a higher chance of having to have caesarean sections or the baby was not scoring well on the Apgar scale (less than 7). These increases didn't appear to be influenced by the type of medication that was used during pregnancy. please click the following web site suggests that the risk of a small amount with the use of ADHD medications during the early stages of pregnancy may be offset by the higher benefit to both mother and child of continued treatment for the woman's condition. Physicians should discuss this with their patients and, if possible, assist them in developing strategies for improving their coping skills which can reduce the effects of her disorder on her daily life and relationships. Interactions with Medication As more women than ever before are being diagnosed with ADHD and being treated with medication, the question of whether to continue or stop treatment during pregnancy is one that doctors are having to have to face. Often, these decisions are taken in the absence of solid and reliable evidence either way, so physicians have to weigh their experience, the experiences of other doctors, and what research suggests about the subject as well as their best judgment for each patient. The issue of potential risks to the infant can be particularly tricky. The research that has been conducted on this topic is based on observations rather than controlled studies, and many of the findings are contradictory. Additionally, the majority of studies limit their analysis to live births, which could underestimate severe teratogenic effects that cause abortion or termination of the pregnancy. The study presented in this journal club addresses these issues by looking at data from both live and deceased births. Conclusion Some studies have revealed an association between ADHD medications and certain birth defects however, other studies haven't found a correlation. Most studies have shown that there is a neutral, or somewhat negative, impact. Therefore, a careful risk/benefit assessment must be done in each situation. It can be challenging, if not impossible for women with ADHD to stop taking their medication. 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 lead to depression and feelings of being isolated. Furthermore, a loss of medication can affect the ability to complete work-related tasks and safely drive which are essential aspects of daily life for a lot of people with ADHD. She suggests that women who aren't sure whether to take the medication or discontinue it due to pregnancy, educate their family members, coworkers and friends about the condition, the impact on daily functioning and the benefits of keeping the current treatment plan. In addition, educating them can aid in ensuring that the woman feels supported when she is struggling with her decision. It is also worth noting that certain drugs can be absorbed 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 can be transferred to the child. Birth Defects Risk As the use of ADHD medication to treat the symptoms of attention deficit hyperactivity disorder (ADHD) increases there are concerns about what impact the drugs could have on the fetuses. A study that was published in the journal Molecular Psychiatry adds to the body of information on this topic. Using two massive data sets researchers were able analyze more than 4.3 million pregnancies and see whether stimulant medication use increased the risk of birth defects. Researchers discovered that, while the risk overall is low, first-trimester ADHD medication exposure was associated with slightly higher risk of specific heart defects such as ventriculoseptal defect. The authors of the study found no association between early use of medication and other congenital abnormalities, such as facial clefting or club foot. The findings are in line with previous studies that have shown an increase, but not significant, in the risk of developing cardiac malformations among women who started taking ADHD medications prior to the time of the time of pregnancy. This risk increased in the later part of pregnancy, when a lot of women are forced to stop taking their medication. Women who were taking ADHD medication during the first trimester were more likely need a caesarean and also have an insufficient Apgar after delivery, and have a baby that needed help breathing after birth. The authors of the study were unable to eliminate selection bias because they limited their study to women who did not have any other medical conditions that could have contributed to the findings. The researchers hope their study will help inform the clinical decisions of doctors who encounter pregnant women. They advise that while a discussion of risks and benefits is important, the decision to stop or continue medication must be based on each woman's needs and the severity of her ADHD symptoms. The authors also caution that while discontinuing the medications is an option, it isn't an option that is recommended due to the high rate of depression and other mental health issues in women who are pregnant or who are recently post-partum. Further, research shows that women who stop taking their medications will have a difficult adjustment to life without them once the baby is born. Nursing The responsibilities of being a new mom can be overwhelming. Women suffering from ADHD may face a lot of challenges when they have to manage their symptoms, attend doctor appointments, prepare for the birth of a child and adjust to a new routine. As such, many women decide to continue taking their ADHD medications throughout the course of pregnancy. The risk for breastfeeding infant is minimal because the majority of stimulant medications is absorbed through breast milk in low amounts. However, the rate of exposure to medications by the infant can differ based on the dosage, frequency it is taken and at what time the medication is administered. Additionally, different drugs enter the infant's system via the gastrointestinal tract, or through breast milk. The effect on the health of a newborn is not completely understood. Some doctors may decide to stop stimulant medication during a woman’s pregnancy due to the lack of research. This is a difficult decision for the patient, who must weigh the benefit of continuing her medication against the potential dangers to the embryo. Until more information is available, doctors should inquire with all pregnant patients about their history of ADHD and if they are taking or planning to take medication during the perinatal period. A increasing number of studies have proven that the majority of women are able to safely continue their ADHD medication during pregnancy and while breastfeeding. This has led to many patients are choosing to do so and in consultation with their physician, they have discovered that the benefits of keeping their current medication outweigh any potential risks. It's important for women with ADHD who are considering breastfeeding to seek out a specialist psychiatrist's advice prior to becoming pregnant. They should discuss the medication they are taking with their physician as well as the pros and cons for continuing treatment. This includes non-pharmacological methods. Psychoeducation is also needed to help pregnant women suffering from ADHD understand the symptoms and the underlying disorder. They should also learn about treatment options and build strategies for coping. This should involve a multidisciplinary approach, which includes the GP, obstetricians and psychiatry. Pregnancy counseling should include discussion of a treatment plan for the mother and the child, and monitoring for signs of deterioration and, if needed modifications to the medication regimen.