ADHD Medication During Pregnancy and Breastfeeding<br /><br />The decision to stop or continue ADHD medication during pregnancy and breastfeeding is challenging for women with the condition. Little data exists about how long-term exposure to these drugs may affect the foetus.<br /><br />A study recently published in Molecular Psychiatry shows that children exposed to ADHD medication during the uterus don't develop neurological developmental disorders such as hearing or vision impairment seizures, febrile seizures or IQ impairment. The authors acknowledge that further high-quality studies are needed.<br /><br />Risk/Benefit Analysis<br /><br />Women who are pregnant and take ADHD medication should weigh the benefits of taking it against the possible dangers for the foetus. Doctors don't have the necessary data to make unequivocal recommendations but they can provide information regarding risks and benefits that aid pregnant women in making informed decisions.<br /><br />A study published in Molecular Psychiatry found that women who used ADHD medications during early pregnancy did not have a significantly increased risk of fetal heart malformations or major structural birth defects. Researchers used a large population-based study of case control to compare the incidence of major structural defects in infants who were born to mothers who took stimulants during pregnancy. Clinical geneticists, pediatric cardiologists and other experts looked over the cases to ensure that the classification was accurate and to minimize any bias.<br /><br /><br /><br />The study of the researchers had some limitations. In particular, they were unable to distinguish the effects of the medication from the disorder that is underlying. This limitation makes it difficult for researchers to determine whether the small associations observed among the exposed groups were due to the use of medication or if they were affected by co-morbidities. In addition the study did not study the long-term outcomes of offspring.<br /><br />The study found that infants whose mothers took ADHD medication during pregnancy were at a slightly greater risk of being admitted to the neonatal care unit (NICU), compared to mothers who did not take any medication during pregnancy, or had quit taking the medication prior to or during pregnancy. This increase was caused by central nervous system disorders. The increased risk of admission was not influenced by the stimulant medication that was used during pregnancy.<br /><br />Women who were taking stimulant ADHD medications during pregnancy also had a higher risk of having to have caesarean sections or one whose baby scored low on the Apgar scale (less than 7). These increases did not appear to be affected by the kind of medication used during pregnancy.<br /><br />Researchers suggest that the small risk of using ADHD medication during pregnancies in the early stages may be offset by the greater benefits to both mother and baby of continuing treatment for the woman's disorder. Physicians should discuss this with their patients and, when possible, assist them in developing strategies to improve coping skills that may minimize the effects of her disorder on her daily life and relationships.<br /><br />Medication Interactions<br /><br />Doctors are increasingly confronted with the dilemma of whether to keep treatment or stop it during pregnancy as more women are diagnosed with ADHD. These decisions are often taken without clear and authoritative evidence. Instead, doctors have to consider their own expertise and experience, as well as the experiences of other doctors and the research that has been conducted on the subject.<br /><br />Particularly, the issue of potential risks to the baby can be a challenge. Many studies on this issue are based on observational data rather than controlled research and their conclusions are often contradictory. Additionally, the majority of studies limit their analysis to live births, which can undervalue the serious teratogenic effects that can result in abortion or termination of the pregnancy. The study presented in this journal club addresses these shortcomings by looking at data from both live and deceased births.<br /><br />The conclusion: While some studies have shown that there is a positive correlation between ADHD medications and the risk of certain birth defects, other studies have found no such relationship, and most studies have a neutral or slightly negative effect. In the end an accurate risk-benefit analysis is required in every situation.<br /><br />It isn't easy, but not impossible for women with ADHD to stop taking their medication. 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 lead to depression and feelings of isolation. In addition, a decrease in medication can affect the ability to perform jobs and drive safely, which are important aspects of daily life for many people with ADHD.<br /><br />She suggests women who are unsure about whether to continue or stop taking medication because of their pregnancy consider educating family members, friends and colleagues about the condition, its impact on daily functioning, and the advantages of continuing the current treatment regimen. It can also help women feel supported in her decision. Certain medications can be passed through the placenta. If a woman decides to not take her ADHD medication while pregnant and breastfeeding, it is important to be aware that the medication may be transferred to her baby.<br /><br />Birth Defects and Risk of<br /><br />As the use and misuse of ADHD medication to treat symptoms of attention deficit hyperactivity disorder (ADHD), increases, so does concern about the possible effects of the drugs on foetuses. A recent study published in the journal Molecular Psychiatry adds to the body of knowledge on this subject. Researchers used two massive data sets to study more than 4.3 million pregnancy and determine if stimulant medication use caused birth defects. Researchers discovered that although the risk overall is low, first-trimester ADHD medication use was associated with slightly higher rates of certain heart defects, like ventriculoseptal defects.<br /><br />The researchers behind the study found no link between early medication use and other congenital anomalies, such as facial clefting or club foot. The results are in line with previous studies revealing the presence of a small, but significant increase in the risk of cardiac malformations among women who started taking ADHD medications prior to the time of pregnancy. This risk increased during the latter half of pregnancy, when a lot of women began to stop taking their medication.<br /><br />Women who took ADHD medications during the first trimester of their pregnancies were also more likely to have a caesarean section, a low Apgar score following delivery, and a baby that required breathing assistance at birth. However the authors of the study were not able to eliminate bias due to selection by restricting the study to women who did not have any other medical conditions that could have contributed to these findings.<br /><br />The researchers hope that their research will aid in the clinical decisions of doctors who encounter pregnant women. They advise that while a discussion of the benefits and risks is important, the decision to stop or continue treatment should be based on each woman's requirements and the severity of her ADHD symptoms.<br /><br />The authors also caution that, while stopping the medication is an option, it isn't an option to consider due to the high rate of depression and other mental health issues in women who are pregnant or recently post-partum. Research has also shown that women who stop taking their medication will have a difficult transitioning to life without them once the baby is born.<br /><br />Nursing<br /><br />The responsibilities of a new mother can be overwhelming. Women with ADHD may face a lot of challenges when they have to manage their symptoms, go to doctor appointments and prepare for the birth of a baby and adjust to a new routine. Many women opt to continue taking their ADHD medication during pregnancy.<br /><br />The majority of stimulant medicines pass through breast milk in very small quantities, so the risk for infant who is breastfeeding is low. The rate of medication exposure will vary based on the dosage the medication is administered, its frequency and the time of day. Additionally, different medications enter the infant's system differently through the gastrointestinal tract and breast milk. The impact of this on a newborn is not yet fully known.<br /><br />Some doctors may decide to stop stimulant medication during a woman's pregnancy due to the absence of research. This is a difficult choice for the patient, who must weigh the benefits of continuing her medication against the potential risks to the embryo. In the meantime, until more information is available, doctors can inquire about pregnant patients if they have an background of ADHD or if they plan to take medication during the perinatal period.<br /><br />Many studies have shown that women can continue taking their ADHD medication in a safe manner during pregnancy and breast-feeding. This has led to an increasing number of patients are choosing to do so and after consulting with their doctor, they have found that the benefits of maintaining their current medication outweigh any risks.<br /><br />It is crucial for women suffering from ADHD who are contemplating breastfeeding to seek out a specialist psychiatrist's advice prior to becoming pregnant. They should discuss their medication with their prescriber and discuss the pros and cons for continuing treatment. This includes non-pharmacological strategies. Psychoeducation is also necessary to help pregnant women with ADHD understand the symptoms and the underlying disorder. They should also be educated about treatment options and build strategies for coping. <a href="https://www.iampsychiatry.uk/adult-adhd-medication/">www.iampsychiatry.uk</a> should include an approach that is multidisciplinary, including the GP as well as obstetricians, psychiatry and obstetricians. Pregnancy counseling should include a discussion of a treatment plan for the mother and child, as well as monitoring for indicators of deterioration, and, if needed modifications to the medication regimen.<br /><br />