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ADHD Medication During Pregnancy and Breastfeeding The choice of whether to stop or continue ADHD medications during pregnancy and nursing is a difficult decision for women suffering from the condition. There aren't many studies regarding how exposure over time may affect the fetus. A study recently published in Molecular Psychiatry shows that children exposed to ADHD medication during the uterus do not develop neurological conditions like impaired vision or hearing seizures, 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 should evaluate the benefits of using it against the possible risks to the fetus. The doctors don't have the information to make unambiguous recommendations, but can provide information about risks and benefits to aid pregnant women in making an informed decision. A study published in Molecular Psychiatry concluded that women who were taking ADHD medication during early pregnancy did not have a greater risk of fetal malformations or structural birth defects. Researchers used a large population-based study of case control to assess the frequency of structural defects that were major in infants born to mothers who were taking stimulants during pregnancy. Pediatric cardiologists and clinical geneticists reviewed the cases to ensure an accurate case classification and to minimize the chance of bias. However, the researchers' study had its limitations. Most important, they were not able to differentiate the effects of the medication from those of the underlying disorder. This limitation makes it difficult for researchers to determine whether the small associations observed among the groups exposed were due to medication use or if they were affected by co-morbidities. Additionally, the researchers did not study long-term offspring outcomes. The study showed that infants whose mothers took ADHD medication during pregnancy had a higher risk of admission to the neonatal care unit (NICU), compared to those whose mothers did not take any medication during pregnancy or stopped taking their medication before or during pregnancy. The reason for this was central nervous system disorders. The higher risk of admission was not influenced by the stimulant medication used during pregnancy. Women who were taking stimulant ADHD medication during pregnancy were also at an increased risk of having a caesarean delivery or having a baby born with low Apgar score (less than 7). buy adhd medication uk did appear to be independent of the type of medication used during pregnancy. Researchers suggest that the minor risk of using ADHD medication during pregnancies in the early stages may be offset by the greater benefits to both baby and mother of continued treatment for the woman's disorder. Doctors should discuss with their patients about this issue and, if possible, help them develop coping skills that can lessen the effects of her disorder on her daily life and relationships. Medication Interactions Many doctors are faced with the decision of whether to keep treatment or stop during pregnancy as more women are diagnosed with ADHD. Most of the time, these decisions are made without 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 the research says on the topic and their own best judgment for each patient. The issue of possible risks to infants is difficult to determine. Many studies on this issue are based on observational data instead of controlled research and their conclusions are often contradictory. The majority of studies limit their analysis to live-births, which could underestimate the severity of teratogenic effects leading to terminations or abortions of pregnancy. The study presented in the journal club addresses these limitations by analyzing information on deceased and live births. The conclusion The conclusion: While certain studies have demonstrated a positive association between ADHD medications and the risk of certain birth defects, others have found no such relationship, and most studies demonstrate a neutral or slight negative effect. As a result, a careful risk/benefit assessment is required in every instance. For women suffering from ADHD and ADD, the decision to stop medication can be difficult, if not impossible. In a recent article published in the Archives of Women's Mental Health by psychologist Jennifer Russell, she notes that stopping ADHD medications during pregnancy can increase depression and feelings of isolation. Furthermore, a loss of medication can interfere with the ability to do jobs and drive safely, which are important aspects of a normal life for many people with ADHD. She suggests that women who are unsure about whether or not to stop medication in light of their pregnancy should consider educating family members, friends and colleagues about the condition, its effects on daily functioning, and the advantages of staying on 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 drugs can pass through the placenta, so if the patient decides to stop her ADHD medication during pregnancy and breastfeeding, she should be aware of the possibility that traces of the drug could be transferred to the child. Risk of Birth Defects As the use of ADHD medication to treat the symptoms of attention deficit hyperactivity disorder (ADHD) grows there are concerns about what impact the medications could have on fetuses. A study that was published in the journal Molecular Psychiatry adds to the existing information on this topic. Utilizing two huge data sets researchers were able examine more than 4.3 million pregnancies and see whether the use of stimulant medications increased the risk of birth defects. Although the risk overall remains low, the researchers did find that first-trimester exposure to ADHD medications was linked to an increased risk of certain heart defects, such as ventriculo-septal defect (VSD). The authors of the study did not discover any link between early medication usage and congenital anomalies like facial deformities, or club feet. The results are in line with previous studies that have shown a small but significant increase in the risk of developing cardiac malformations among women who began taking ADHD medications prior to the time of pregnancy. This risk increased in the latter half of pregnancy, as many women decide to stop taking their ADHD medication. Women who took ADHD medication during the first trimester were more likely need a caesarean and also have an insufficient Apgar after delivery, and had a baby that required breathing assistance at birth. However, the authors of the study were not able to eliminate selection bias by limiting the study to women who did not have any other medical issues that could have contributed to the findings. The researchers hope their research will help inform the clinical decisions of doctors who encounter pregnant women. The researchers advise that, while discussing the risks and benefits are crucial, the decision regarding whether or not to stop taking medication should be in light of the severity of each woman's ADHD symptoms and her needs. The authors also warn that while discontinuing the medications is an alternative, it is not an option to consider due to the high rate of depression and other mental health problems among women who are pregnant or recently post-partum. Furthermore, research suggests that women who decide to stop taking their medications are more likely to experience a difficult time adapting to life without them after the baby's arrival. Nursing It can be overwhelming to become a mom. Women with ADHD who have to deal with their symptoms while attending doctor appointments as well as preparing for the arrival of a baby and adapting to new routines in the home may face a lot of challenges. As such, many women choose to continue taking their ADHD medications throughout the course of pregnancy. The risk for nursing infant is low because the majority of stimulant medication passes through breast milk at low levels. The rate of medication exposure will differ based on dosage the medication is administered, its frequency and time of day. In addition, different medications enter the baby’s system via the gastrointestinal tract or breast milk. The impact of these medications on a newborn's health is not fully known. Some doctors may decide to stop stimulant medication during a woman's pregnancy due to the absence of research. This is a difficult decision for the woman, who must weigh the benefits of taking her medication as well as the risk to the embryo. In the meantime, until more information is available, GPs may inquire about pregnant patients if they have a background of ADHD or if they intend to take medication during the perinatal period. A increasing number of studies have proven that most women can safely continue to take their ADHD medication during pregnancy and while breastfeeding. This has led to more and more patients opt to do this and, in consultation with their doctor they have discovered that the benefits of maintaining their current medication far outweigh any potential risks. Women with ADHD who plan to breastfeed should seek advice from an expert psychiatrist prior to becoming pregnant. They should discuss their medication with their doctor and discuss the pros and cons of continuing treatment. This includes non-pharmacological strategies. Psychoeducation should also be provided to help women with ADHD recognize their symptoms and the underlying disorder and learn about treatment options and strengthen existing strategies for managing. This should include a multidisciplinary approach with the GP, obstetricians and psychiatry. Pregnancy counselling should include the discussion of a treatment plan for both the mother and child, monitoring for signs of deterioration and the need for adjustments to the medication regimen.