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ADHD Medication During Pregnancy and Breastfeeding Women suffering from ADHD must make a difficult decision regarding whether or not to stop taking ADHD medication during pregnancy and breast-feeding. 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 shows that children exposed to ADHD medication during the uterus do not develop neurological disorders like hearing or vision impairment seizures, febrile seizures or IQ impairment. The authors acknowledge that further high-quality research is needed. Risk/Benefit Analysis Pregnant women who use ADHD medications must weigh the advantages of taking them against potential risks to the foetus. Doctors don't have the information needed to make unequivocal recommendations but they can provide information regarding benefits and risks that can help pregnant women make informed decisions. A study published in Molecular Psychiatry concluded that women who were taking ADHD medication in early pregnancy did not have a higher risk of fetal malformations, or structural birth defects. Researchers used a large sample-based case control study to compare the incidence of major structural defects in infants born to mothers who were taking stimulants during pregnancy. Pediatric cardiologists and clinical geneticists examined the cases to ensure correct case classification and to minimize the chance of bias. However, the researchers' study was not without its flaws. In particular, they were unable to separate the effects of the medication from those of the underlying disorder. This limitation makes it difficult for researchers to establish whether the few associations observed between the groups exposed were due to medication use, or if they were confounded by the presence of comorbidities. Additionally the study did not examine long-term offspring outcomes. The study showed that infants whose mother took ADHD medication during pregnancy were at a slightly higher risk of admission to the neonatal care unit (NICU) in comparison to mothers who did not use any medication during pregnancy or had stopped taking their medication before or during pregnancy. The reason for this was central nervous system disorders. The higher risk of admission was not affected by the stimulant medications used during pregnancy. Women who were taking stimulant ADHD medication during pregnancy were also at an elevated risk of having a caesarean delivery or having a baby with 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 small risk associated with the use of ADHD medications during the early stages of pregnancy may be offset by the greater benefit to both mother and child of continuing treatment for the woman's condition. Physicians should discuss the issue with their patients and, where they are able, assist them in developing strategies to improve coping skills that can lessen the effects of her disorder on her daily life and relationships. adult adhd medication are increasingly faced with the decision of whether to continue treatment or stop during pregnancy as more women are diagnosed with ADHD. These decisions are frequently made without clear and reliable evidence. Instead, doctors must consider their own expertise, the experience of other physicians and the research on the topic. The issue of risk to infants is difficult to determine. The research on this subject is based on observation instead of controlled studies and the results are conflicting. Most studies focus on live-births, which could underestimate the severity of teratogenic effects that can lead to abortions or terminations of pregnancy. The study discussed in this journal club addresses these limitations by analyzing data on live and deceased births. Conclusion Some studies have found an association between ADHD medications and certain birth defects However, other studies haven't shown such a relationship. The majority of studies show a neutral, or even somewhat negative, effect. In every case an in-depth study of the benefits and risks must be performed. For women suffering from ADHD who suffer from ADHD, the decision to stop taking medication is difficult if not impossible. In a recent article in the Archives of Women's Mental Health by psychologist Jennifer Russell, she notes that stopping ADHD medications during pregnancy can cause depression and feelings of isolation. In addition, a decrease in medication may affect the ability to complete work-related tasks and safely drive which are essential aspects of a normal life for a lot of people with ADHD. She recommends that women who are unsure about whether or not to stop medication in light of their pregnancy should consider the possibility of educating friends, family members, and coworkers on the condition, its impact on daily functioning, and the advantages of continuing the current treatment plan. It can also help a woman feel supported in her decision. It is important to remember that certain medications are able to be absorbed through the placenta so if a woman decides to stop her ADHD medication during pregnancy and breastfeeding, she must be aware of the possibility that traces of the drug 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 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. Researchers used two massive data sets to study over 4.3 million pregnancy and determine if stimulant medication use increased the risk of birth defects. Researchers found that while the overall risk is low, the first trimester ADHD exposure to medication was associated with slightly higher risk of certain heart defects, like ventriculoseptal defect. The researchers of the study didn't discover any connection between early use of medication and other congenital anomalies, such as facial deformities or club feet. The results are in agreement with previous studies which showed a small, but significant increase in the number of cardiac malformations among women who began taking ADHD medication prior to the time of the time of pregnancy. The risk was higher in the later part of pregnancy, when many women are forced to stop taking their ADHD medications. Women who took ADHD medication during the first trimester were more likely require a caesarean birth or have a low Apgar after birth and have a baby who needed help breathing when they were born. The researchers of the study were not able to eliminate selection bias because they limited their study to women without other medical conditions that could have contributed to the findings. Researchers hope that their study will provide doctors with information when they meet pregnant women. They advise that while discussing risks and benefits is important but the decision to stop or maintain treatment must be based on each woman's requirements and the severity of her ADHD symptoms. The authors also warn that even though stopping the medication is an alternative, it is not an option that is recommended due to the high rate of depression and other mental health issues among women who are pregnant or who are recently post-partum. Additionally, research suggests that women who stop taking their medication will have a tough transitioning to life without them once the baby is born. Nursing It can be a challenge to become a mom. Women with ADHD who have to manage their symptoms while attending physician appointments and preparing for the arrival of their child and adjusting to new household routines can experience severe challenges. Many women decide to continue taking their ADHD medication during pregnancy. The risk to a breastfeeding infant is minimal because the majority of stimulant medication is absorbed through breast milk at a low level. The rate of exposure to medication will differ based on dosage and frequency of administration as well as time of day. In addition, various drugs enter the infant's system via the gastrointestinal tract or breast milk. The impact of these medications on the health of a newborn isn't fully comprehended. Some doctors may decide to stop stimulant medication during a woman’s pregnancy due to the lack of research. This is a difficult decision for the mother, who must weigh the advantages of her medication against the risk to the fetus. Until more information is available, doctors should ask all pregnant patients about their experience with ADHD and if they are taking or planning to take medication during the perinatal time. A increasing number of studies have revealed that the majority of women are able to safely continue their ADHD medication during pregnancy and breastfeeding. As a result, more and more patients are choosing to do so and after consulting with their doctor, they have discovered that the benefits of continuing their current medication far outweigh any potential risks. It is essential for women with ADHD who are considering breastfeeding to seek out a specialist psychiatrist's advice prior to becoming pregnant. They should review their medications with their prescriber and discuss the advantages and disadvantages of continued treatment, including non-pharmacological management strategies. Psychoeducation is also needed to help pregnant women with ADHD recognize the signs and the underlying disorder. They should also be informed about treatment options and strengthen the coping mechanisms. This should be a multidisciplinary approach including obstetricians, GPs, and psychiatry. Counselling for pregnancy should include discussion of a management plan for both the mother as well as the child, monitoring for signs of deterioration and the need for adjustments to the medication regimen.