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ADHD Medication During Pregnancy and Breastfeeding Women suffering from ADHD face a difficult decision about whether to continue or stop taking ADHD medication during pregnancy and breastfeeding. There aren't enough data regarding how exposure over time may affect the foetus. A study recently 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 more high-quality studies are needed. Risk/Benefit Analysis Women who are pregnant and take ADHD medication must weigh the benefits of taking it versus the dangers for the baby. Physicians don't have the data to provide clear recommendations, but can provide information on the risks and benefits to assist pregnant women to make an informed decision. A study published in Molecular Psychiatry found that women who used ADHD medications during their early pregnancy did not have a significantly higher risk of fetal cardiac malformations or major structural birth defects. The researchers used a large population-based study of case-control to evaluate the incidence of major structural birth defects in infants born to mothers who took stimulants during the early stages of pregnancy, and those who did not. Clinical geneticists, pediatric cardiologists and other experts examined the cases to ensure that the classification was correct and to minimize any bias. The research conducted by the researchers was not without limitations. The most important issue was that they were unable to distinguish the effects of the medication from those of the disorder that is underlying. That limitation makes it difficult to know whether the limited associations observed in the exposed groups result from medication use or comorbidities that cause confusion. The researchers also did not look at long-term outcomes for the offspring. The study found that babies whose mothers had taken ADHD medication during pregnancy were at a slightly higher chance of being admitted to the neonatal care unit (NICU), compared to mothers who didn't take any medication during pregnancy or stopped taking their medication before or during pregnancy. The reason for this was central nervous system-related disorders and the increased risk of admission was not found to be influenced by the stimulant medications were used during pregnancy. Women who were taking stimulant ADHD medications during pregnancy also had a higher risk of having to have an emergency caesarean section or having a baby that scored low on the Apgar scale (less than 7). These increases appeared to be independent of the type of medication used during pregnancy. The researchers suggest that the risk of a small amount with the use of ADHD medications during early pregnancy could be offset by the higher benefit to both the mother and child of continuing treatment for the woman's condition. Physicians should talk to their patients about this issue and, if possible, help them improve coping skills which could reduce the effects of her disorder on her daily life and relationships. Medication Interactions As more women than ever before are being diagnosed with ADHD and being treated with medication, the dilemma of whether or not to stop treatment during pregnancy is one that more and more doctors have to face. adhd anxiety medication of the time, these decisions are made without clear and authoritative evidence either way, so physicians must weigh what they know from their own experiences, those of other doctors, and what research suggests on the subject as well as their own best judgment for each individual patient. Particularly, the subject of possible risks to the infant can be difficult. The research on this issue is based on observation rather than controlled studies, and a lot of the results are conflicting. The majority of studies focus on live-births, which could underestimate the severity of teratogenic effects which can cause 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 found a correlation. Most studies show a neutral, or even slightly negative, impact. In every case an in-depth analysis of the potential risks and benefits is required. For a lot of women with ADHD and ADD, the decision to stop medication is difficult if not impossible. In an article recently published in the 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 patients with ADHD. Furthermore, adhd anxiety medication of medication may affect the ability to complete jobs and drive safely which are essential aspects of daily life for many people suffering from ADHD. She recommends that women who are unsure about whether or not to discontinue medication due to their pregnancy should consider informing family members, friends and colleagues on the condition, its impact on daily functioning, and the benefits of keeping the current treatment plan. Educating them can also aid in ensuring that the woman feels supported as she struggles with her decision. It is important to note that some medications can be absorbed through the placenta so if the patient decides to stop taking her ADHD medication during pregnancy and breastfeeding, she should be aware that the effects of the medication could be transferred to the child. Risk of Birth Defects As the use and misuse of ADHD medications to treat the symptoms of attention deficit disorder hyperactivity disorder (ADHD), increases the concern over the possible effects of the drugs on fetuses. A study that was published in the journal Molecular Psychiatry adds to the body of knowledge on this subject. Researchers used two massive data sets to examine over 4.3 million pregnancies and determine whether stimulant medications increased birth defects. Researchers discovered that, while the overall risk is low, the first trimester ADHD medication exposure was associated with slightly higher risk of specific heart defects like ventriculoseptal defects. The researchers of the study found no link between early medication use and other congenital anomalies, like facial clefting, or club foot. The results are in the same vein as previous studies that showed the existence of a slight, but significant increase in cardiac malformations for women who began taking ADHD medication prior to pregnancy. The risk was higher in the latter half of pregnancy, as many women begin to discontinue their ADHD medications. Women who took ADHD medication in the first trimester of their pregnancy were also more likely to experience caesarean section, low Apgar score after delivery and a baby who required help breathing at birth. However adhd anxiety medication of the study were not able to eliminate selection bias by restricting the study to women who didn't have other medical issues that could be a contributing factor to these findings. The researchers hope their study will serve to inform the clinical decisions of doctors who encounter pregnant women. The researchers suggest that while discussing the risks and benefits are important, the decision about whether to continue or stop medication should be in light of the severity of each woman's ADHD symptoms and the needs of the woman. The authors also caution that while discontinuing the medications is an option, it isn't a recommended practice because of the high incidence of depression and other mental health problems for women who are expecting or who are recently postpartum. Additionally, the research suggests that women who choose to stop taking their medications are more likely to have a difficult time getting used to life without them after the baby's arrival. Nursing The responsibilities of being a new mom can be overwhelming. Women suffering from ADHD are often faced with a number of difficulties when they have to manage their symptoms, attend doctor appointments, prepare for the birth of a baby and adjust to a new routine. Therefore, many women decide to continue taking their ADHD medications throughout pregnancy. The risk to breastfeeding infant is not too high since the majority of stimulant medications is absorbed through breast milk at a low level. The rate of medication exposure will differ based on dosage, frequency of administration and the time of day. In addition, different medications enter the baby’s system via the gastrointestinal tract, or through breast milk. The impact of these medications on the health of a newborn isn't completely comprehended. Because of the lack of research, some physicians may be inclined to discontinue stimulant medications during the course of pregnancy. This is a difficult decision for the woman who must weigh the benefits of her medication against the potential risks to the foetus. As long as more information is available, GPs can ask pregnant patients if they have a history of ADHD or if they plan to take medication during the perinatal phase. A growing number of studies have revealed that women can continue their ADHD medication during pregnancy and while breastfeeding. This has led to many patients opt to do this and after consulting with their doctor, they have found that the benefits of keeping their current medication outweigh any risks. It is essential for women with ADHD who are thinking of breastfeeding to seek 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 should also be offered to help women with ADHD be aware of their symptoms and underlying disorder, learn about available treatments and to reinforce existing strategies for coping. This should involve a multidisciplinary approach, which includes the GP, obstetricians and psychiatry. The pregnancy counselling should consist of the discussion of a treatment plan for both the mother and child, as well as monitoring for signs of deterioration and, if necessary, adjustments to the medication regimen.