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ADHD Medication During Pregnancy and Breastfeeding The choice of whether to stop or continue ADHD medications during pregnancy and breastfeeding is challenging for women with the condition. There is a lack of information about how long-term exposure to these medications can affect the foetus. A study recently published in Molecular Psychiatry demonstrates that children exposed to ADHD medication during pregnancy do not develop neurological problems like hearing loss or vision, febrile seizures or IQ impairment. The authors acknowledge that further high-quality research is needed. Risk/Benefit Analysis Women who are pregnant and taking ADHD medication should weigh the benefits of taking it against the possible risks to the foetus. Physicians do not have the data needed to provide clear recommendations however they can provide information about benefits and risks that can assist pregnant women in making informed choices. A study published in Molecular Psychiatry concluded that women who took ADHD medication during their early pregnancy were not at a higher risk of fetal malformations or structural birth defects. Researchers conducted a massive population-based study of case control to assess the frequency of major structural defects in infants who were born to mothers who were taking stimulants during pregnancy. Full Survey , clinical geneticists and other experts looked over the cases to ensure that the classification was correct and to reduce any bias. The study conducted by the researchers had some limitations. The most important issue was that they were unable to distinguish the effects of the medication from the effects of the disorder that is underlying. This 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. The researchers also did not study long-term outcomes for offspring. The study revealed that infants whose mothers had taken ADHD medication during pregnancy were at a slightly higher risk of admission to the neonatal care unit (NICU) in comparison to those whose mothers did not take any medication during pregnancy or discontinued taking their medication prior to or during pregnancy. The reason for this was central nervous system-related disorders and the increased risk of admission did not appear to be influenced by the stimulant medication was used during pregnancy. Women who were taking stimulant ADHD medications during pregnancy also had a higher chance of having to have caesarean sections or a baby that scored low on the Apgar scale (less than 7). These increases didn't appear to be influenced by the kind of medication used during pregnancy. Researchers suggest that the minor risks associated with the use ADHD medications during early pregnancies may be offset by the greater benefits for mother and baby from continuing treatment for the woman's disorder. Physicians should discuss the issue with their patients and, if possible, help them develop strategies to improve their coping abilities that can lessen the effects of her disorder on her daily functioning and relationships. Medication Interactions More and more doctors are confronted with the dilemma of whether to continue treatment or stop it during pregnancy as more women are diagnosed with ADHD. The majority of these decisions are made in the absence of any evidence that is clear and definitive in either case, which means that doctors must weigh their knowledge from their own experiences, those of other doctors, and what research suggests about the subject, along with their own best judgment for each patient. The issue of risk to infants is extremely difficult. The research on this subject is based on observation instead of controlled studies and a lot of the results are contradictory. Furthermore, most studies restrict their analysis to live births, which may underestimate severe teratogenic effects that lead to abortion or termination of the pregnancy. The study that is discussed in the journal club addresses these shortcomings, by examining both the data from deceased and live births. The conclusion is that while some studies have shown an association between ADHD medications and the possibility of certain birth defects, other studies have not found any evidence of a link and the majority of studies show a neutral or even slightly negative effect. In every case it is imperative to conduct a thorough analysis of the risks and benefits should be conducted. It can be challenging, if not impossible for women suffering from ADHD to stop taking their medication. In fact, in an article published in the Archives of Women's Mental Health psychologist Jennifer Russell notes that stopping ADHD medication during pregnancy can lead to increased depression, feelings of isolation, and family conflict for these patients. The loss of medication can also affect the ability to safely drive and complete work-related tasks, which are crucial aspects of normal life for those with ADHD. She suggests women who are uncertain about whether to continue or discontinue medication due to their pregnancy should consider the possibility of educating friends, family members and colleagues about the condition, its impact on daily life, and the advantages of continuing the current treatment regimen. It can also help a woman feel confident about her decision. It is important to note that certain medications are able to pass through the placenta so if a woman decides to stop her ADHD medication during pregnancy and breastfeeding, she must be aware that traces of the drug could be transferred to the child. Risk of Birth Defects As the use and abuse of ADHD medications to treat the symptoms of attention deficit disorder hyperactivity disorder (ADHD) increases as does the concern about the potential effects of these drugs on foetuses. A recent study published in the journal Molecular Psychiatry adds to the existing information on this topic. With two massive data sets researchers were able look at more than 4.3 million pregnancies and determine whether stimulant medications increased the risk of birth defects. Researchers discovered that, while the risk overall is low, first-trimester ADHD exposure to medication was associated with slightly higher rates of certain heart defects, like ventriculoseptal defect. The authors of the study found no connection between the use of early medications and other congenital anomalies, like facial clefting, or club foot. The results are in line with previous studies that have shown a small but significant increase in the risk of cardiac malformations among women who started taking ADHD medications prior to pregnancy. This risk increased during the latter half of pregnancy, when a lot of women stopped taking their medication. Women who used ADHD medications in the first trimester of pregnancy were also more likely to experience caesarean sections, a low Apgar score after delivery and a baby that required breathing assistance during birth. The researchers of the study could not eliminate selection bias because they limited the study to women without other medical conditions that could have contributed to the findings. Researchers hope that their study will help doctors when they meet pregnant women. The researchers advise that, while discussing the risks and benefits are important, the decision about whether to continue or stop medication should be based on the severity of each woman's ADHD symptoms and her needs. The authors caution that, while stopping the medication is an option to think about, it isn't advised because of the high incidence of depression and other mental problems in women who are expecting or have recently given birth. Additionally, research suggests that women who stop taking their medications will have a difficult adjustment to life without them after the baby is born. Nursing It can be a challenge becoming a mother. Women with ADHD who have to manage their symptoms while attending doctor 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 breastfeeding infant is not too high since the majority of stimulant medications passes through breast milk at low levels. However, the rate of exposure to medications by the newborn may differ based on the dosage, frequency it is administered, and the time of day it is administered. Additionally, different medications enter the baby's system differently through the gastrointestinal tract and breast milk, and the effect of this on a newborn isn't yet fully understood. Because of the lack of research, some doctors may be inclined to discontinue stimulant drugs during a woman's pregnancy. This is a difficult decision for the woman who must weigh the benefits of taking her medication as well as the risks to the fetus. As long as more information is available, doctors can ask pregnant patients if they have any background of ADHD or if they are planning to take medication during the perinatal period. Numerous studies have proven that women can continue to take their ADHD medication without risk during pregnancy and breast-feeding. In the end, more and more patients are choosing to do so, and after consulting with their doctor, they have found that the benefits of continuing their current medication far outweigh any risks. It is essential for women with ADHD who are considering breastfeeding to seek a specialist psychiatrist's advice prior becoming pregnant. They should review their medications with their physician and discuss the pros and cons of continued treatment, including non-pharmacological strategies. Psychoeducation is also needed to help pregnant women suffering from ADHD understand the symptoms and underlying disorder. They should also be educated about treatment options and strengthen the coping mechanisms. This should be a multidisciplinary process together with obstetricians, GPs and psychiatrists. The pregnancy counselling should consist of discussion of a management plan for both the mother and child, as well as monitoring for signs of deterioration, and the need for adjustments to the medication regimen.