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ADHD Medication During Pregnancy and Breastfeeding The decision to stop or keep ADHD medications during breastfeeding and pregnancy is challenging for women with the condition. There is a lack of information about how long-term exposure to these drugs could affect the fetus. medication for adult add published in Molecular Psychiatry shows that children exposed to ADHD medication during utero do not develop neurological developmental conditions like hearing or vision impairment seizures, febrile seizures or IQ impairment. The authors acknowledge the need for higher-quality research. Risk/Benefit Analysis Pregnant women who use ADHD medications need to balance the benefits of using them against the risks to the fetus. Doctors don't have enough data to make unambiguous recommendations however they can provide information about risks and benefits to assist pregnant women to make informed choices. A study published in Molecular Psychiatry concluded that women who were taking ADHD medication during their early pregnancy were not at higher risk of fetal malformations, or structural birth defects. The researchers used a large, population-based case-control study to determine the prevalence of major structural birth defects in babies born to mothers who took stimulants during early pregnancy and those who had not. Clinical geneticists and pediatric cardiologists reviewed the cases to ensure accurate classification of the cases and to reduce the chance of bias. However, the researchers' study was not without its flaws. The researchers were not able to, in the first place to distinguish the effects triggered by the medication from the disorder. This limitation makes it difficult for researchers to determine whether the small associations observed among the groups exposed were due to the use of medication, or if they were affected by the presence of comorbidities. Researchers also did not look at long-term outcomes for offspring. The study did reveal that babies whose mothers had taken ADHD medication during pregnancy were at a higher risk of being admitted to the neonatal intensive care unit (NICU) than infants who were born without any medication or stopped their medications before or during pregnancy. The reason for this was central nervous system disorders. The increased risk of admission was not influenced by the stimulant medication that was used during pregnancy. Women who took stimulant ADHD medication during pregnancy also had an elevated chance of having a caesarean section or having a child with an low Apgar score (less than 7). These increases appear to be unrelated to the type of medication used during pregnancy. The researchers suggest that the low risk associated with the use of ADHD medications during the early stages of pregnancy could be offset by the higher benefit for both mother and child from continued treatment for the woman's disorder. Doctors should discuss with their patients about this issue and, if possible, help them improve coping skills which can lessen the impact of her disorder in her daily life and 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 usually made without clear and reliable evidence. Instead, doctors must consider their own expertise and experience, as well as the experiences of other doctors, and the research on the topic. In particular, the issue of potential risks for the infant can be difficult. The research that has been conducted on this topic is based on observation rather than controlled studies, and many of the findings are conflicting. Most studies focus on live births, which may underestimate the severity of teratogenic effects leading to terminations or abortions of pregnancy. The study presented in the journal club addresses these shortcomings by analyzing both data on live and deceased births. Conclusion A few studies have revealed an association between ADHD medications and certain birth defects However, other studies haven't found a correlation. Most studies show that there is a neutral, or somewhat negative, impact. In every case an in-depth study of the potential risks and benefits must be performed. For women suffering from ADHD, the decision to stop medication is difficult if not impossible. In a recent piece published in Archives of Women's Mental Health by psychologist Jennifer Russell, she notes that stopping ADHD medications during pregnancy can increase depression and feelings of being isolated. medication for adult add of medication can affect the ability to drive safely and complete work-related tasks, which are essential aspects of normal life for those suffering from ADHD. She suggests that women who are unsure whether to take the medication or stop it due to their pregnancy should educate family members, colleagues, and acquaintances about the condition, its effects on daily functioning, and the benefits of keeping the current treatment plan. Educating them can also help the woman feel supported in her struggle with her decision. It is also worth noting that some medications are able to pass through the placenta therefore, if a patient decides to stop taking her ADHD medication during pregnancy and breastfeeding, she must be aware that traces of the drug could be passed on to the baby. Birth Defects and Risk of As the use of ADHD medication to treat the symptoms of attention deficit hyperactivity disorder (ADHD) increases there are concerns about the effects that the drugs might have on foetuses. Recent research published in the journal Molecular Psychiatry has added to the body knowledge on this subject. Researchers used two huge data sets to study over 4.3 million pregnancies and determine whether stimulant medications increased birth defects. Although the risk overall remains low, the scientists did find that first-trimester exposure to ADHD medications was associated with an increased risk of specific heart defects, like ventriculo-septal defects (VSD). The researchers of the study found no connection between the use of early medications and congenital abnormalities such as facial clefting or club foot. The results are in agreement with previous studies that have shown a small, but significant increase in the number of cardiac malformations among women who began taking ADHD medication prior to pregnancy. The risk grew in the later part of pregnancy, when a lot of women decide to stop taking their medication. Women who used ADHD medications in the first trimester of their pregnancies were also more likely to experience caesarean sections, a low Apgar score following delivery, and a baby who needed breathing assistance during birth. However the researchers of the study were unable to eliminate selection bias by limiting the study to women who did not have other medical issues that could be a contributing factor to these findings. Researchers hope their research will help doctors when they meet pregnant women. The researchers recommend that, while discussing benefits and risks are important, the choice about whether to continue or stop medication should be made in light of the severity of each woman's ADHD symptoms and her needs. The authors also warn that, while stopping the medication is an alternative, it is not a recommended practice because of the high rate of depression and other mental health problems among women who are pregnant or post-partum. Further, research shows that women who stop taking their medication will have a harder time adjusting to a life without them once the baby is born. Nursing The responsibilities that come with being a new mom can be overwhelming. Women who suffer from ADHD can face severe challenges when they must deal with their symptoms, go to doctor appointments and prepare for the birth of a child and adjust to new routines. Many women choose to continue taking their ADHD medication during pregnancy. The risk for breastfeeding infant is minimal because the majority of stimulant medication is absorbed through breast milk in low amounts. The rate of medication exposure can vary depending upon the dosage and frequency of administration as well as time of day. In addition, individual medications enter the infant's system differently through the gastrointestinal tract and breast milk. The impact of this on a newborn is not well understood. Due to the absence of evidence, some doctors may be inclined to discontinue stimulant medications during a woman's pregnancy. This is a difficult decision for the patient, who must balance the benefit of continuing her medication with the potential dangers to the embryo. Until more information is available, doctors should ask all pregnant patients about their experience with ADHD and whether they are taking or planning to take medication during the perinatal period. A growing number of studies have shown that most women can safely continue their ADHD medication during pregnancy and breastfeeding. This has led to an increasing number of patients opt to do this and in consultation with their physician, they have found that the benefits of maintaining their current medication far exceed any risk. Women who suffer from ADHD who are planning to breastfeed should seek the advice of a specialist psychiatrist prior to becoming pregnant. They should discuss their medication with their prescriber, and the pros and cons of continuing treatment. This includes non-pharmacological methods. Psychoeducation should also be offered to help pregnant women suffering from ADHD recognize their symptoms and the underlying disorder and learn about treatment options and strengthen existing strategies for coping. This should be a multidisciplinary approach with the GP as well as obstetricians, psychiatry and obstetricians. Pregnancy counselling should include the discussion of a treatment plan for both mother and child, and monitoring for signs of deterioration and the need for adjustments to the medication regimen.