ADHD Medication During Pregnancy and Breastfeeding

The choice of whether to stop or continue ADHD medication during breastfeeding and pregnancy is a challenge for women suffering from the condition. There aren't enough data on how exposure to ADHD for a long time could affect a fetus.

A recent study published in Molecular Psychiatry shows that children exposed to ADHD medication in utero do not develop neurological disorders like impaired vision or hearing 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 advantages of taking them against potential risks to the fetus. The doctors don't have the information to make unambiguous recommendations, but can provide information about risks and benefits to help pregnant women make informed choices.

A study published in Molecular Psychiatry found that women who took ADHD medications during early pregnancy did not have an higher risk of fetal cardiac malformations or major birth defects that are structural. Researchers conducted a massive population-based case control study to examine the prevalence of structural defects that were major in infants who were born to mothers who took stimulants during pregnancy. Pediatric cardiologists and clinical geneticists examined the cases to ensure accurate case classification and to minimize the chance of bias.

The study conducted by the researchers had some limitations. The researchers were not able, in the first place, to separate the effects caused by the medication from the disorder. This limitation makes it difficult for researchers to establish whether the few associations observed between the groups that were exposed to the use of medication or if they were confounded by co-morbidities. Additionally, the researchers did not study the long-term effects of offspring on their parents.

The study found that infants whose mothers had taken ADHD medication during pregnancy were at a slightly higher chance of being admitted to the neonatal care unit (NICU) in comparison to mothers who did not take 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 medications during pregnancy also had a higher likelihood of having an emergency caesarean section or having the baby was not scoring well on the Apgar scale (less than 7). These increases did not appear to be affected by the type of medication that was used during pregnancy.

Researchers suggest that the small risk of using ADHD medication during pregnancies in the early stages could be offset by the more beneficial outcomes for both mother and baby from continuing treatment for the woman's disorder. Physicians should talk to their patients about this issue and as much as possible, assist them develop coping skills that may reduce the impact of her disorder in her daily life and relationships.

Medication Interactions

As more women than ever before are being diagnosed with ADHD and being treated with medication, the issue of whether or not to end treatment during pregnancy is a question that more and more physicians have to face. The majority of these decisions are taken in the absence of solid and reliable evidence either way, so physicians must weigh what they know from their own experiences, those of other doctors, and what the research suggests about the subject and their best judgment for each individual patient.

Particularly, the issue of potential risks for the baby can be tricky. The research on this subject is based on observation instead of controlled studies and the results are contradictory. Furthermore, most studies restrict their analysis to live births, which could undervalue the serious teratogenic effects that can cause abortion or termination of the pregnancy. most effective adhd medication for adults presented in this journal club addresses these shortcomings by looking at data from both live and deceased births.

Conclusion: While some studies have found a positive correlation between ADHD medications and certain birth defects however, other studies haven't established a link. Most studies show a neutral, or even slightly negative, effect. In the end an accurate risk-benefit analysis must be done in each case.

For a lot of women with ADHD, the decision to discontinue medication is difficult, if not impossible. In fact, in a recent article in Archives of Women's Mental Health psychologist Jennifer Russell notes that stopping ADHD medication during pregnancy can cause depression, feelings of loneliness, and family conflict for patients with ADHD. In addition, a decrease in medication can interfere with the ability to complete job-related tasks and drive safely that are crucial aspects of daily life for a lot of people with ADHD.

She suggests women who are uncertain about whether to continue or stop medication in light of their pregnancy should consider educating family members, friends, and coworkers on the condition, its impact on daily functioning, and the advantages of staying on the current treatment regimen. It can also aid in ensuring that the woman feels supported as she struggles with 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 could be passed on to her baby.

Birth Defects and Risk of

As the use of ADHD medication to treat the symptoms of attention deficit hyperactivity disorder (ADHD) grows as do concerns about what impact the medications could have on fetuses. A recent study published in the journal Molecular Psychiatry adds to the body of knowledge on this subject. With two massive data sets researchers were able examine more than 4.3 million pregnancies to determine whether stimulant medication use increased the risk of birth defects. Researchers found that while the risk overall is low, first-trimester ADHD medication use was associated with slightly higher risk of specific heart defects like ventriculoseptal defect.

The authors of the study could not discover any link between the use of early medications and other congenital anomalies, like facial deformities or club feet. The results are in line with previous studies showing a small but significant increase in the risk of cardiac malformations among women who began taking ADHD medications prior to the birth of their child. This risk increased in the latter half of pregnancy, as many women begin to discontinue their ADHD medication.

Women who took ADHD medication during the first trimester were more likely to require a caesarean birth or have an insufficient Apgar after birth and had a baby that required help breathing after birth. However the researchers of the study were unable to eliminate bias due to selection by restricting the study to women who did not have other medical issues that could be a contributing factor to these findings.


Researchers hope their research will inform physicians when they see pregnant women. They recommend that, while the discussion of the risks and benefits is crucial but the decision to stop or keep medication must be based on each woman's requirements and the severity of her ADHD symptoms.

The authors also advise that, while stopping the medication is an option, it is not an option to consider due to the high incidence of depression and other mental health issues in women who are pregnant or recently post-partum. Furthermore, research suggests that women who decide to stop their medications are more likely to experience a difficult time adjusting to life without them after the baby's arrival.

Nursing

The responsibilities that come with being a new mom can be overwhelming. Women who suffer from ADHD who have to deal with their symptoms while attending doctor appointments as well as making preparations for the arrival of a child and adjusting to new household routines may face a lot of challenges. As such, many women choose to continue taking their ADHD medications throughout the course of pregnancy.

The majority of stimulant medications are absorbed through breast milk in small amounts, so the risk for infant who is breastfeeding is low. The rate of exposure to medication will vary based on the dosage and frequency of administration as well as time of day. Additionally, different medications enter the body of the baby differently through the gastrointestinal tract as well as breast milk, and the effect of this on a newborn infant is not well understood.

Due to the absence of evidence, some doctors might be tempted to stop taking stimulant medications during the course of pregnancy. This is a difficult decision for the woman who must weigh the advantages of continuing her medication against the potential risks to the fetus. As long as more information is available, GPs can inquire about pregnant patients if they have any background of ADHD or if they are planning to take medication in the perinatal period.

Many studies have shown that women can continue to take their ADHD medication without risk during pregnancy and breast-feeding. In response, a growing number of patients are opting to do so. They have discovered, in consultation with their physicians, that the benefits of keeping their current medication outweigh risk.

Women who suffer from ADHD who are planning to breastfeed should seek advice from a specialist psychiatrist prior to becoming pregnant. They should discuss their medication with their prescriber as well as the pros and cons of continuing treatment. This includes non-pharmacological strategies. Psychoeducation is also necessary to help pregnant women suffering from ADHD understand the symptoms and underlying disorder. They should also be informed about treatment options and strengthen the coping mechanisms. This should be a multidisciplinary approach with the GPs, obstetricians and psychiatrists. Pregnancy counseling should include discussion of a treatment plan for the mother and child, and monitoring for indicators of deterioration, and, if needed, adjustments to the medication regime.