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ADHD Medication During Pregnancy and Breastfeeding Women suffering from ADHD must make a difficult decision about whether to continue or stop taking ADHD medication during pregnancy and breast-feeding. There is adhd uk medication of information about how long-term exposure to these medications may affect the fetus. A recent study published in Molecular Psychiatry shows that children exposed to ADHD medication during the uterus do not develop neurological disorders such as impaired vision or hearing seizures, febrile seizures or IQ impairment. The authors acknowledge that more high-quality studies are required. Risk/Benefit Analysis Women who are expecting and taking ADHD medication should evaluate the benefits of using it versus the dangers for the fetus. Physicians don't have the information needed to give clear guidelines but they can provide information regarding the risks and benefits to help pregnant women make informed decisions. A study published in Molecular Psychiatry found that women who used ADHD medications during early pregnancy did not face an increased risk of fetal heart malformations or major structural birth defects. Researchers conducted a large, population-based case-control study to assess the risk of major structural birth defects in babies born to mothers who had taken stimulants in the early stages of pregnancy and those who had not. Pediatric cardiologists, clinical geneticists and other experts examined the cases to make sure that the classification was correct and to reduce any bias. However, the study had its limitations. The researchers were not able in the beginning, to separate the effects triggered by the medication from the disorder. This limitation makes it difficult for researchers to establish whether the small associations observed among the groups exposed were due to medication use or affected by co-morbidities. The researchers also did not examine long-term outcomes for offspring. The study found that babies whose mothers took ADHD medication during pregnancy had a slightly greater risk of being admitted to the neonatal care unit (NICU), compared to those whose mothers did not use any medication during pregnancy, or had quit taking the medication prior to or during pregnancy. This increase was due to central nervous system disorders, and the increased risk of admission did not appear to be affected by the type of stimulant medications were taken during pregnancy. Women who were taking stimulant ADHD medications during pregnancy also had a higher risk of having to have a caesarean section or one whose baby scored low on the Apgar scale (less than 7). These increases appear to be unrelated to 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 greater benefits to both mother and child of continuing treatment for the woman's disorder. Physicians should speak with their patients about this and try to help them develop coping skills that can lessen the effects of her disorder on her daily life and relationships. Medication Interactions More and more doctors are confronted with the dilemma of whether to keep treatment or stop 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 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 own best judgment for each patient. In particular, the issue of possible risks to the baby can be tricky. Many studies on this subject are based on observations rather than controlled research and their conclusions are often contradictory. Additionally, the majority of studies limit their analysis to live births, which could underestimate the severity of teratogenic effects that could result in abortion or termination of the pregnancy. The study that is discussed in this journal club addresses these shortcomings by analyzing data on live and deceased births. Conclusion Some studies have found a positive correlation between ADHD medications and certain birth defects however, other studies haven't shown such a relationship. Most studies show a neutral, or even somewhat negative, effect. In every case, a careful study of the potential risks and benefits is required. It isn't easy, but 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 cause depression, feelings of isolation and family conflict for patients with ADHD. Furthermore, a loss of medication can affect the ability to perform job-related tasks and drive safely which are essential aspects of daily life for a lot of people with ADHD. She suggests women who are uncertain about whether to keep or stop taking medication because of their pregnancy consider the possibility of educating friends, family members and colleagues on the condition, its impact on daily functioning, and the benefits of keeping the current treatment plan. Educating them can also make the woman feel more comfortable when she is struggling with her decision. Certain medications can be passed through the placenta. If the patient decides not to take her ADHD medication while pregnant and breastfeeding, it is crucial to be aware that the medication could be transferred to the baby. Birth Defects Risk As the use of ADHD drugs to treat symptoms of attention deficit hyperactivity disorder (ADHD) grows as do concerns about the effects that the medications could have on the fetuses. A study that was published in the journal Molecular Psychiatry adds to the existing knowledge about this subject. Researchers used two massive datasets to analyze more than 4.3 million pregnant women and determine if stimulant medication use caused birth defects. Researchers discovered that, while the risk overall is low, the first trimester ADHD medication use was associated with slightly higher risk of certain heart defects, such as ventriculoseptal defect. The authors of the study did not discover any connection between early medication usage and other congenital anomalies, like facial deformities or club feet. The results are in agreement with previous studies which showed a small, but significant increase in cardiac malformations for women who started taking ADHD medication prior to the time of the birth of their child. This risk increased during the latter stages of pregnancy when a large number of women began to stop taking their medication. Women who were taking ADHD medication during the first trimester were more likely to require a caesarean delivery, have a low Apgar after birth and had a baby that required help breathing at birth. However the researchers of the study were unable to eliminate selection bias by restricting the study to women who didn't have any other medical conditions that could have contributed to the findings. Researchers hope that their study will inform physicians when they encounter pregnant women. The researchers advise that, while discussing the risks and benefits are crucial, the decision about whether to continue or stop medication should be made in light of the severity of each woman's ADHD symptoms and the needs of the woman. The authors caution that, although stopping the medication is a possibility to think about, it isn't recommended due to the high prevalence of depression and other mental problems for women who are pregnant or recently gave birth. Further, the research suggests that women who choose to stop their medications are more likely to have a difficult time getting used to life without them following the birth of their baby. Nursing The responsibilities of being a new mom can be overwhelming. Women who suffer from ADHD can face severe challenges when they have to manage their symptoms, go to doctor appointments and prepare for the birth of a baby and adjust to new routines. This is why many women elect to continue taking their ADHD medication throughout the pregnancy. The majority of stimulant medications are absorbed by breast milk in small quantities, so the risk to infant who is breastfeeding is low. However, the frequency of exposure to medications by the newborn can vary depending on the dosage, frequency it is administered and the time of the day the medication is administered. Additionally, different medications enter the infant's system differently through the gastrointestinal tract as well as breast milk. The impact of this on a newborn infant is not well known. Due to the absence of research, some physicians may be inclined to discontinue stimulant medication during a woman's pregnancy. It is a difficult decision for the mother, who must weigh the benefits of continuing her medication against the potential risks to the embryo. Until more information becomes available, doctors can ask pregnant patients whether they have any background of ADHD or if they plan to take medication in the perinatal period. Numerous studies have proven that women can continue to take their ADHD medication safely while breastfeeding and during pregnancy. This has led to more and more patients choose to do so and, in consultation with their doctor they have discovered that the benefits of continuing their current medication far outweigh any potential risks. Women with ADHD who plan to breastfeed should seek the advice of a specialist psychiatrist before becoming pregnant. They should review their medications with their prescriber and discuss the advantages and disadvantages of continued treatment, including non-pharmacological strategies. Psychoeducation is also required to help women with ADHD be aware of their symptoms and underlying disorder Learn about the available treatment options and strengthen existing strategies for coping. This should be a multidisciplinary approach with the GP, obstetricians and psychiatry. Pregnancy counseling should consist of a discussion of a treatment plan for the mother and child, monitoring of signs of deterioration, and, if needed, adjustments to the medication regime.