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ADHD Medication During Pregnancy and Breastfeeding Women suffering from ADHD have to make a difficult choice about whether to continue or stop taking ADHD medication during pregnancy and breast-feeding. There are few data on how long-term exposure may affect the fetus. A study recently published in Molecular Psychiatry demonstrates that children exposed to ADHD medication during pregnancy do not develop neurological problems such as impaired hearing or vision, febrile seizures, or IQ impairment. The authors acknowledge that more high quality research is needed. Risk/Benefit Analysis Women who are pregnant and taking ADHD medication must evaluate the benefits of using it against the potential risks for the baby. Doctors don't have the data needed to provide clear recommendations however they can provide information on benefits and risks that can help pregnant women make informed decisions. A study published in Molecular Psychiatry found that women who used ADHD medications during early pregnancy did not have an increased risk of fetal cardiac malformations or major birth defects that are structural. The researchers used a large population-based study of case-control to evaluate the incidence of major structural birth defects in infants born to mothers who had taken stimulants during the early stages of pregnancy, and those who did not. Clinical geneticists and pediatric cardiologists reviewed the cases to ensure an accurate case classification and to minimize the possibility of bias. The research conducted by the researchers was not without limitations. The most important issue was that they were unable to distinguish the effects of the medication from the disorder at hand. That limitation makes it difficult to know whether the limited associations observed in the groups that were exposed are due to the use of medication or comorbidities that cause confusion. Additionally the study did not look at the long-term outcomes of offspring. The study found that babies whose mothers had taken ADHD medication during pregnancy had a greater risk of being admitted to the neonatal care unit (NICU) as compared to those whose mothers did not use any medication during pregnancy or stopped taking their medication before or during pregnancy. This was due to central nervous system disorders. The higher risk of admission was not affected by the stimulant medication that was used during pregnancy. Women who were taking stimulant ADHD medications during pregnancy also had a higher chance of having to have a caesarean section or the baby was not scoring well on the Apgar scale (less than 7). These increases did 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 greater benefits to both the mother and child of continuing treatment for the woman's disorder. Doctors should discuss with their patients about this issue and, if possible, help them improve coping skills which may reduce the impact of her disorder in her daily functioning and her relationships. Medication Interactions Many doctors are faced with the decision of whether to continue treatment or stop during pregnancy as more women are diagnosed with ADHD. These decisions are often made without clear and authoritative evidence. Instead, physicians must weigh their own knowledge in conjunction with the experiences of other physicians and the research that has been conducted on the subject. Particularly, the issue of possible risks to the infant can be difficult. Many of the studies on this topic are based on observations instead of controlled research and their findings are often contradictory. In addition, most studies limit their analysis to live births, which can underestimate the severity of teratogenic effects that could result in abortion or termination of the pregnancy. The study discussed in this journal club addresses these limitations by analyzing data on live and deceased births. The conclusion: While certain studies have demonstrated an association between ADHD medications and the possibility of certain birth defects, others have found no connection and the majority of studies have a neutral or slightly negative impact. Therefore an accurate risk-benefit analysis must be done in each situation. For women suffering from ADHD and ADD, 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. A loss of medication may also impact the ability to drive safely and complete work-related tasks, which are essential aspects of everyday life for those with ADHD. She recommends women who are unsure about whether or not to stop taking medication because of their pregnancy, consider the possibility of educating friends, family members and colleagues on the condition, its effects on daily functioning, and the advantages of continuing the current treatment regimen. It can also help women feel more confident in her decision. Certain medications can pass through the placenta. If a patient decides to not take her ADHD medication while breastfeeding, it's important to be aware that the medication may be transferred to her baby. Risk of Birth Defects As the use of ADHD medications to treat symptoms of attention deficit hyperactivity disorder (ADHD) increases, so do concerns about the effects that the drugs could have on foetuses. Recent research published in the journal Molecular Psychiatry has added to the body knowledge on this issue. With two massive data sets researchers were able to analyze more than 4.3 million pregnancies and see whether stimulant medication use increased the risk of birth defects. Although most effective adhd medication for adults remains low, the researchers did find that first-trimester exposure to ADHD medications was linked to an increase in the risk of certain heart defects like ventriculo-septal defects (VSD). The researchers of the study found no connection between early use of medication 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 cardiac malformations for women who started taking ADHD medication prior to the birth of their child. This risk increased during the latter stages of pregnancy when many women began to stop taking their medication. Women who were taking ADHD medication in the first trimester were more likely to need a caesarean or have a low Apgar after birth and had a baby that required help breathing when they were born. The researchers of the study were unable to eliminate bias due to selection because they limited their study to women who did not have any other medical conditions that could have contributed to the findings. Researchers hope that their study will provide doctors with information when they encounter pregnant women. The researchers recommend that, while discussing benefits and risks are important, the decision regarding whether or not to stop medication should be based on the severity of each woman's ADHD symptoms and the needs of the woman. The authors caution that, while stopping the medication is a possibility to look into, it is not advised due to the high rate depression and mental health issues in women who are expecting or who have recently given birth. Further, research shows that women who stop taking their medication will have a harder transitioning to life without them after the baby is born. Nursing It can be a challenge to become a mother. Women who suffer from ADHD who have to manage their symptoms while attending doctor appointments as well as getting ready for the arrival of a baby and getting used to new routines at home may face a lot of challenges. Therefore, many women decide to continue taking their ADHD medications throughout the course of pregnancy. The risk to a breastfeeding infant is not too high since the majority of stimulant medications is absorbed through breast milk at low levels. The amount of exposure to medications will vary based on the dosage, frequency of administration and time of day. Additionally, individual medications enter the body of the baby differently through the gastrointestinal tract as well as breast milk and the impact of this on a newborn isn't well known. Some physicians may discontinue stimulant medication during a woman’s pregnancy due to the lack of research. This is a complicated decision for the patient, who must balance the benefit of continuing her medication against the potential risks to the embryo. In the meantime, until more information is available, doctors should inquire with all pregnant patients about their history of ADHD and whether they are planning or taking to take medication during the perinatal time. A growing number of studies have proven that most women can safely continue taking their ADHD medication while they are pregnant and nursing. In the end, more and more patients opt to do this and, in consultation with their doctor they have found that the benefits of continuing their current medication far exceed any risk. It's important for women with ADHD who are considering breastfeeding to seek a specialist psychiatrist's advice prior to becoming pregnant. They should discuss the medication they are taking with their physician, and the pros and cons for continuing treatment. This includes non-pharmacological methods. Psychoeducation is also necessary to help pregnant women suffering from ADHD recognize the signs and the underlying disorder. They should also be educated about treatment options and strengthen the coping mechanisms. This should involve an approach that is multidisciplinary, including the GP, obstetricians and psychiatry. Pregnancy counseling should consist of a discussion of a treatment plan for the mother and the child, as well as monitoring for signs of deterioration and, if needed, adjustments to the medication regime.