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ADHD Medication During Pregnancy and Breastfeeding

The decision to stop or keep ADHD medication during pregnancy and breastfeeding is a challenge for women suffering from the condition. Little data exists about how long-term exposure to these drugs may affect the fetus.

A study recently published in Molecular Psychiatry shows that children exposed to ADHD medication during the uterus do not develop neurological conditions like hearing loss or impaired vision seizures, febrile seizures, or IQ impairment. The authors acknowledge that more high-quality research is needed.

Risk/Benefit Analysis

Pregnant women who use ADHD medications must weigh the benefits of taking them against potential risks to the foetus. Physicians do not have the necessary data to make unequivocal recommendations, but they can provide information about risks and benefits that aid pregnant women in making informed decisions.


A study published in Molecular Psychiatry concluded that women who took ADHD medication in early pregnancy were not at higher risk of fetal malformations, or structural birth defects. Researchers conducted a massive population-based study of case control to compare the incidence of major structural defects in infants born to mothers who were taking stimulants during pregnancy. Clinical geneticists, pediatric cardiologists and other experts reviewed the cases in order to confirm that the classification was correct and to reduce any bias.

The study of the researchers was not without its limitations. Researchers were unable to, in the first place to distinguish the effects of the medication from the disorder. This makes it difficult to know whether the small associations observed in the exposed groups are due to the use of medication or confounding by comorbidities. The researchers did not study long-term outcomes for the offspring.

The study did show that infants whose mothers took ADHD medications during pregnancy were at a greater risk of being admitted to the neonatal intensive care unit (NICU) than infants who were born without any medication or had stopped their medications before or during pregnancy. This was due to central nervous system disorders. The increased risk of admission was not influenced by the stimulant medication that was used during pregnancy.

Women who were taking stimulant ADHD medication during pregnancy also had an elevated chance of having a caesarean section or having a baby born with low Apgar score (less than 7). These increases did appear to be unrelated to the type of medication used during pregnancy.

Researchers suggest that the minor risk of using ADHD medications during early pregnancies may be offset by the greater benefits to both mother and baby from continuing treatment for the woman's disorder. Physicians should speak with their patients about this and try to help them develop coping strategies that may reduce the impact of her disorder in her daily functioning and her relationships.

Interactions with Medication

Doctors are increasingly faced with the decision of whether to continue treatment or stop it during pregnancy as more women are diagnosed with ADHD. These decisions are often made without clear and reliable evidence. Instead, medication for adult add must consider their own expertise, the experience of other doctors and the research that has been conducted on the subject.

The issue of risk to infants is particularly tricky. The research that has been conducted on this topic is based on observations rather than controlled studies, and many of the findings are conflicting. In addition, most studies limit their analysis to live births, which may underestimate the severity of teratogenic effects that could lead to abortion or termination of the pregnancy. The study that is discussed in the journal club addresses these shortcomings by analyzing information on deceased and live births.

Conclusion A few studies have shown an association between ADHD medications and certain birth defects However, other studies haven't found a correlation. The majority of studies show that there is a neutral, or slightly negative, effect. In the end, a careful risk/benefit assessment must be done in each case.

For a lot of women with ADHD, the decision to stop taking medication can be difficult, if not impossible. In fact, in an article recently published in Archives of Women's Mental Health psychologist Jennifer Russell notes that stopping ADHD medication during pregnancy can lead to increased depression, feelings of isolation and family conflict for those suffering from the disorder. In addition, a decrease in medication may affect the ability to perform jobs and drive safely which are essential aspects of a normal life for a lot of people with ADHD.

She recommends that women who are unsure about whether to continue or stop medication in light of their pregnancy should consider informing family members, friends and colleagues on the condition, its impact on daily life, and the advantages of staying on the current treatment plan. In addition, educating them can aid in ensuring that the woman feels supported when she is struggling with her decision. It is also worth noting that certain drugs can pass through the placenta so if a woman decides to discontinue her ADHD medication during pregnancy and breastfeeding, she must be aware that traces of the medication could be transferred to the child.

Risk of Birth Defects

As the use and misuse of ADHD medication to treat symptoms of attention deficit disorder hyperactivity disorder (ADHD), increases the concern over the possible effects of the drugs on the fetuses. Recent research published in the journal Molecular Psychiatry has added to the body of knowledge regarding this issue. With two massive data sets researchers were able analyze more than 4.3 million pregnancies and determine whether stimulant medications increased the risk of birth defects. While the overall risk remains low, the researchers found that exposure in the first trimester to ADHD medicines was associated with a slightly higher rate of specific heart defects, like ventriculo-septal defects (VSD).

The authors of the study found no link between early use of medication and other congenital anomalies, like facial clefting, or club foot. The results are consistent with previous studies revealing an increase, but not significant, in the risk of cardiac malformations among women who started taking ADHD medications prior to the time of pregnancy. The risk grew in the latter half of pregnancy, as many women are forced to stop taking their ADHD medication.

Women who were taking ADHD medication during the first trimester were more likely require a caesarean delivery and also have a low Apgar after delivery, and have a baby who needed breathing assistance at birth. The researchers of the study could not eliminate selection bias because they restricted the study to women who did not have any other medical conditions that might have contributed to the findings.

The researchers hope that their research will help inform the clinical decisions of physicians who see pregnant women. The researchers suggest that while discussing benefits and risks are important, the choice regarding whether or not to stop taking medication should be in light of the severity of each woman's ADHD symptoms and her needs.

The authors also advise that even though stopping the medication is an option, it isn't an option to consider due to the high rate of depression and other mental health problems among women who are pregnant or who are recently post-partum. Additionally, the research suggests that women who choose to stop their medications are more likely to have difficulties getting used to life without them following the birth of their baby.

Nursing

It can be a challenge becoming a mother. Women who suffer from ADHD are often faced with a number of difficulties when they must manage their symptoms, attend doctor appointments, prepare for the birth of a baby and adjust to a new routine. Therefore, many women elect to continue taking their ADHD medications throughout the course of pregnancy.

The majority of stimulant medicines are absorbed by breast milk in very small amounts, therefore the risk to nursing infant is very low. However, the amount of medication exposure to the infant can differ based on the dosage, frequency it is administered, and the time of day the medication is administered. Additionally, different medications enter the baby’s system through the gastrointestinal tract or through breast milk. The impact on a newborn's health is not 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 woman who must weigh the benefits of taking her medication as well as the risks to the embryo. In the meantime, until more information is available, doctors should ask all pregnant patients about their history of ADHD and if they plan or are taking to take medication during the perinatal time.

A increasing number of studies have proven that most women can safely continue their ADHD medication while they are pregnant and nursing. This has led to more and more patients are choosing to do so and, in consultation with their physician, they have found that the benefits of maintaining their current medication exceed any risk.

Women with ADHD who are planning to breastfeed should seek the advice of a specialist psychiatrist prior to becoming pregnant. They should review their medications with their doctor and discuss the advantages and disadvantages of continuing treatment, including non-pharmacological management strategies. Psychoeducation is also needed to help pregnant women suffering from ADHD understand the symptoms and the underlying disorder. They should also be informed about treatment options and strengthen coping mechanisms. This should be a multidisciplinary effort together with obstetricians, GPs, and psychiatrists. Pregnancy counseling should include a discussion of a treatment plan for the mother as well as the child, and monitoring for indicators of deterioration, and, if needed modifications to the medication regime.

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