title: Methylphenidate use in pregnancy and lactation: a systematic review of evidence.
abstract: OBJECTIVE
  The aims of this review were to summarize the scientific evidence about the risks of using methylphenidate for ADHD in pregnancy and lactation, to present a case in which interruption of treatment after delivery and during breastfeeding was harmful and to discuss the implications of treating or not treating ADHD in pregnancy and lactation.
  
  
  METHODS
  For the systematic review, databases searched included Pubmed, Psychinfo, Web of Science, Embase, Biosis and Medline.
  
  
  RESULTS
  Three articles were found with a total sample of 41 children exposed to methylphenidate in pregnancy. Malformations reported included congenital heart defects (n = 2), finger abnormalities (syndactyly, adactyly and polydactyly n = 2) and limb malformations (n = 1). Other problems included premature birth, asphyxia and growth retardation. One case report (n = 1) and one case series (n = 3) were identified regarding exposure to methylphenidate through breast feeding. In all cases, children developed normally and no adverse effects were reported. In our case report we describe an infant exposed to methylphenidate during pregnancy and breast feeding, who developed normally having no detectable congenital abnormalities.
  
  
  CONCLUSIONS
  The number and size of the studies found were small. Identified cases were not representative of the general adult ADHD population having methylphenidate as monotherapy during pregnancy as all the articles reported combinations of methylphenidate with either known teratogenic drugs or drugs of abuse. There is a paucity of data regarding the use of methylphenidate in pregnancy and further studies are required. Although the default medical position is to interrupt any non-essential pharmacological treatment during pregnancy and lactation, in ADHD this may present a significant risk. Doctors need to evaluate each case carefully before interrupting treatment.
authors.affiliation: Academic Unit of Psychiatry, University of Bristol, Bristol, UK.
authors.forename: Blanca M
authors.initials: BM
authors.lastname: Bolea-Alamanac
authors.forename: Amy
authors.initials: A
authors.lastname: Green
authors.forename: Gauri
authors.initials: G
authors.lastname: Verma
authors.forename: Penelope
authors.initials: P
authors.lastname: Maxwell
authors.forename: Simon J C
authors.initials: SJ
authors.lastname: Davies
mesh_terms: D000293:Adolescent; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy*; D001942:Breast Feeding; D002657:Child Development / Q000187:drug effects; D005260:Female; D006801:Humans; D007223:Infant; D007774:Lactation; D008774:Methylphenidate / Q000008:administration & dosage / Q000009:adverse effects* / Q000493:pharmacokinetics / Q000627:therapeutic use*; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects / Q000139:chemically induced / Q000453:epidemiology; D055815:Young Adult
chemical_list: D008774:Methylphenidate
keywords: ADD; ADHD; hyperactivity; lactation; methylphenidate; pregnancy