ADHD Medication During Pregnancy and Breastfeeding

The decision to stop or continue ADHD medications during pregnancy and nursing is a difficult decision for women suffering from the condition. There are few data on how long-term exposure may affect the fetus.

A study recently published in Molecular Psychiatry shows that children exposed to ADHD medication in the uterus don't develop neurological disorders like hearing or vision impairment seizures, febrile seizures, or IQ impairment. The authors acknowledge that more high-quality research is needed.

Risk/Benefit Analysis

Pregnant women who take ADHD medications need to balance the benefits of using them against the risks to the fetus. Physicians don't have the data to give clear advice but they can provide information on the risks and benefits to help pregnant women make informed decisions.

A study published in Molecular Psychiatry found that women who took ADHD medications in early pregnancy did not face an increased risk of fetal cardiac malformations or major birth defects that are structural. Researchers conducted a large, population-based case-control study to assess the risk of major structural birth defects in infants born to mothers who had taken stimulants during early pregnancy, and those who did not. Clinical geneticists, pediatric cardiologists and other experts reviewed the cases in order to confirm that the classification was accurate and to minimize any bias.

The study conducted by the researchers was not without its limitations. In particular, they were unable to distinguish the effects of the medication from those of the disorder that is underlying. That limitation makes it difficult to determine whether the small associations observed in the exposed groups are due to medication use or confounding by comorbidities. Additionally, the researchers did not look at the long-term outcomes of offspring.

The study did find that infants whose mothers took ADHD medications during pregnancy were at slightly greater risk of being admitted to the neonatal intensive care unit (NICU) than infants who were born without any medication or had taken off their 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 medications used during pregnancy.

Women who used stimulant ADHD medication during pregnancy were also at an elevated risk of having a caesarean section or having a baby with an low Apgar score (less than 7). These increases didn't appear to be affected by the kind of medication used during pregnancy.

The researchers suggest that the risk of a small amount with the use of ADHD medications during the early stages of pregnancy may be offset by the higher benefit to both the mother and child of continuing treatment for the woman's disorder. Physicians should discuss the issue with their patients and, if possible, assist them in developing strategies to improve coping skills which can reduce the impact of her disorder on her daily life and 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 usually taken without clear and authoritative evidence. Instead, doctors must take into account their own experience and experience, as well as the experiences of other physicians and the research on the topic.

Particularly, the subject of possible risks to the baby can be tricky. A lot of studies on this topic are based on observational evidence rather than controlled research and their findings are often contradictory. In addition, most studies limit their analysis to live births, which could underestimate severe teratogenic effects that lead to abortion or termination of the pregnancy. The study discussed in the journal club addresses these limitations by analyzing information on deceased and live births.

Conclusion: While some studies have shown an association 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, impact. In the end an accurate risk-benefit analysis must be done in each situation.

For many women with ADHD, the decision to discontinue medication can be difficult, if not impossible. 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 increase depression, feelings of loneliness and family conflict for these patients. In addition, a decrease in medication can interfere with the ability to do jobs and drive safely that are crucial aspects of a normal life for many people with ADHD.

She suggests that women who aren't sure whether to continue taking medication or discontinue it due to pregnancy, educate their family members, colleagues, and acquaintances about the condition, the effects on daily functioning, and the advantages of staying on the current treatment. It can also help a woman feel confident about her decision. It is important to note that certain medications are able to pass through the placenta so if a woman decides to stop her ADHD medication during pregnancy and breastfeeding, she must be aware that the effects of the drug could be passed on to the baby.

Risk of Birth Defects

As the use and use of ADHD drugs to treat symptoms of attention deficit disorder hyperactivity disorder (ADHD) increases the concern over the potential adverse effects of the drugs on the fetuses. Recent research published in the journal Molecular Psychiatry has added to the body of knowledge on this issue. With two massive data sets researchers were able look at more than 4.3 million pregnancies to determine whether stimulant medication use increased the risk of birth defects. Although the risk overall remains low, the researchers did find that first-trimester exposure to ADHD medicines was associated with a slightly higher rate of certain heart defects, such as ventriculo-septal defect (VSD).

The researchers of the study found no link between the use of early medications and other congenital abnormalities, like facial clefting, or club foot. The results are in the same vein as previous studies that have shown a small, but significant increase in the number of cardiac malformations among women who began taking ADHD medication before the birth of their child. The risk increased in the latter stages of pregnancy when a large number of women began to stop taking their medication.

Women who took ADHD medication during the first trimester were more likely to require a caesarean delivery or have an insufficient Apgar after delivery and have a baby who needed help breathing after birth. However, web page of the study were unable to eliminate bias due to selection by limiting the study to women who didn't have any other medical conditions that could have contributed to these findings.

Researchers hope their research will inform physicians when they see pregnant women. They suggest that although the discussion of the risks and benefits is crucial, the decision to stop or continue medication should be based on each woman's needs and the severity of her ADHD symptoms.

The authors also advise that while discontinuing the medications is an alternative, it is not an option that is recommended due to the high prevalence of depression and other mental health problems for women who are expecting or postpartum. Additionally, the research suggests that women who decide to stop taking their medication are more likely to experience a difficult time getting used to life without them after the baby's arrival.

Nursing

It can be overwhelming to become a mom. Women suffering from ADHD can face severe challenges when they must deal with their symptoms, attend doctor appointments, prepare for the birth of a baby and adjust to a new routine. Many women choose to continue taking their ADHD medication during pregnancy.

The risk for nursing infant is low because the majority of stimulant medication passes through breast milk at a low level. The rate of medication exposure can vary depending upon the dosage the medication is administered, its frequency and the time of day. Additionally, individual medications enter the baby's system differently through the gastrointestinal tract and breast milk, and the effect of this on a newborn is not fully understood.

Some physicians may discontinue stimulant medications during a woman's pregnancy due to the lack of research. This is a complicated decision for the patient, who must weigh the benefits of continuing her medication against the possible risks to the fetus. Until more information is available, GPs should ask all pregnant patients about their experience with ADHD and whether they are taking or planning to take medication during the perinatal period.

Numerous studies have proven that women can continue to take their ADHD medication in a safe manner during pregnancy and while breast-feeding. This has led to more and more patients are choosing to do so, and in consultation with their doctor they have found that the benefits of maintaining their current medication far outweigh any risks.


Women with ADHD who plan to breastfeed should seek advice from a specialist psychiatrist prior to becoming pregnant. They should review their medications with their prescriber and discuss the pros and cons of continued treatment, including non-pharmacological management strategies. Psychoeducation should also be offered to help pregnant people with ADHD be aware of their symptoms and underlying disorder and learn about treatment options and reinforce existing coping strategies. This should be a multidisciplinary effort including obstetricians, GPs, and psychiatrists. Pregnancy counseling should include discussion of a treatment plan for the mother as well as the child, and monitoring for signs of deterioration and, if necessary adjustments to the medication regime.