Do not begin taking any medication again, even one that you have previously taken, until you have guidance from a physician who knows your personal health history. "LR[~1j@`A*a\;B_>bSz"8T.H (6-48 months) of breastfeeding. For most lactating mothers with ADHD, benefits of breastfeeding. It is important to speak with your doctor and discuss your concerns and possibility of alternative therapies. [PubMed. Use of the term mother or maternal refers to a person who is pregnant. Anybody else? According to studies on the use of various medications and drugs during pregnancy, adverse reactions primarily occurred in infants younger than two months of age. Most sources generally do not recommend the use of Adderall in breastfeeding mothers due to the risk of side effects. My Dr said that even though I was breastfeeding & on my meds, little if none gets passed through the breast milk. nchavez@mothertobaby.org, Copyright 2023 The Organization of Teratology Information Specialists, MotherToBaby, a service of the Organization of Teratology Information Specialists. Some evidence suggests that large doses of dextroamphetamine could lower milk supply in people who are newly breastfeeding. If concerned about the formulation, monitor the breastfed infant for symptoms.3. My GP knew I was taking Met and that I'm TTC. Last updated on Jul 17, 2022. I hated, hated the side effects of Rittalin, (no appetite and a wound up feeling) but with my job as a teacher I was scared I would become a disorganized mess without it. Staff, New Mother's Guide to Breastfeeding, 2nd Edition. According to the AAP, health care providers should weigh the risks and benefits when prescribing medications to breastfeeding mothers by considering the Neuropharmacology. Having said all of the above, there may be situations where Adderall use while nursing is warranted if the benefits outweigh the risks. Methods: Seven women taking metformin (median dose 1500 mg orally daily) and their infants were studied. While she has patients who do breastfeed while taking the medication, it's at their own comfort level knowing that there isn't a lot of data about the potential risks. You should consult your healthcare provider for breastfeeding advice related to your particular situation. Every pregnancy starts out with a 3-5% chance of having a birth defect. stream One sizeable prospective study found no adverse effects in breastfed infants. The answer as to whether or not it is safe to take Adderall while breastfeeding isn't so straightforward, says Carly Snyder, MD, a reproductive and perinatal psychiatrist and member of the Verywell Family review board. Two lactating women who were 14 and 14.5 months postpartum took a single dose of 500 mg of immediate-release metformin. If I take 20 mg of regular adderall (not the extended release) at 7 am will it be out of my system by 7pm and would it be safe to breastfeed at that time? Please check each of the links below, where breastfeeding (lactation) ADHD in adulthood is associated with significant impairment in occupational, academic, and social functioning.7The mechanism of action of stimulants (methylphenidate and amphetamines) in thereduction of ADHD symptoms is not fully known8, but most likely involves the improvement of daily functioning via increased neurotransmission of dopamine and norepinephrine.8 Breastfeeding mothers should be aware that stimulants have a higher potential for misuse9 and dependence than other ADHD medications.10 Regardless of the treatment of choice it important for a breastfeeding mother to use her medication as prescribed5,11 to minimize infant exposure. If you choose not to take Adderall while breastfeeding, consult with your healthcare provider to make a decision about the best course of action. Small studies did not notice side effects in infants who nursed from mothers taking Adderall in the short term. Adderall is the brand name for a prescription drug used to treat ADHD. Kelly Kamenetzky is a Los Angeles-based freelance writer/editor with more than a decade of experience covering the parenting and family space. An Update on the Pharmacotherapy of Attention-Deficit/Hyperactivity Disorder in Adults., Wilens, et al. Use of the term father or paternal refers to a person who contributes sperm. But check with your doctor, as the amount of insulin you need may Additionally, studies also show that mothers who breastfeed are more likely to recover more quickly from childbirth and also have reduced rates of certain types of cancer (e.g. However, many people with attention deficit hyperactive disorder experience episodes which are more frequent and often more intense. Stimulants These are the most widely used ADHD medications because they typically provide great results. time it takes for 50% of a drug to be metabolized in the body). "It is prudent to monitor a child who is breastfeeding from a mother who is onAdderall," says Dr. Mouanness. Some sources recommend against Adderall use while breastfeeding, while others suggest that regularly prescribed doses of Adderall will have negligible effects. "From a purely emotional standpoint [people with ADHD] can find themselves feeling ineffective without it. While there are no known effects of Adderall on a breastfeeding baby, there is also limited research in this area, so there are possible unknown risks. ADHD is a chronic condition characterized by symptoms like hyperactivity, attention difficulty, and impulsiveness. There are only two reports of infants breastfeeding while their mothers were treated with amphetamine stimulants. Amphetamines were detectable in breast milk at low levels; blood levels of drug were assessed in one of the infants, and blood levels of amphetamine were detectable but very low. Maternal dosages were 20 mg and 35 mg per day. I have it on my medical HelloPharmacist that may be a contraindication to breastfeeding. So, now I'm worried about the effect the two medications might have. solubility, size, blood level, protein binding, oral bioavailability, and half-lifecan influence the transfer of drugs into breast milk. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances. %PDF-1.4 Important: Adderall is a drug containing multiple ingredients. 4 0 obj The only bad effects I have had are from the met. 944 0 obj
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Disclaimer: Information presented in this database is not meant as a substitute for professional judgment. Nonstimulants These medications are newer and were first used in 2003. Is Mucinex Safe To Take When Breastfeeding?
Hello, How long does 10mg of Adderall (IR) remain in breast milk? Adderall is present in the breast milk when taken by nursing mothers.
A)o[7 According to the AAP, health care providers should weigh the risks and benefits when prescribing medications to breastfeeding mothers by considering the following: Need for the drug by the mother. Potential effects of the drug on milk production. Amount of the drug excreted into human milk. Extent of oral absorption by the breastfeeding infant. All times are GMT-5. Six of the women were taking an immediate-release product 500 mg three times daily and one was taking 500 mg as a sustained-release product once daily. Neuroscience & Biobehavioral Reviews. Available for Android and iOS devices. We recommend infant safety and monitoring when mothers taking ADHD drugs wish to breastfeed. Every breastfeeding journey is different. ~D?_97w0/Iq!L$J|_ ~gy>~c9F)=t$j}+q//vJVLm^AKM} >;[gYGUn3T>F>l.3#oBhPv[0t!->^8Le->z4ZdM4;Ao5v~_^;8JpZwDlF`0h86p9K$d@_/
cA.TlkD[KKfju Transfer of metformin into human milk. Another study did not find differences in learning or development children at age two who were exposed to metformin compared to children who were exposed to insulin. When the breast milk was tested,dextroamphetaminewas found in measurable concentrations andsome of the infants in the study had measurable concentrations ofdextroamphetaminein their blood. Our website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Many stimulant ADHD medications work to amplify the effects of antidepressants. The dosage they recommend once you've stopped breastfeeding may be different than what they prescribed before. Furthermore, extended-release formulations will not have the same spikes of drug in the blood and milk as seen in immediate-release forms, so timing breastfeeding around medication may not be necessary. Milk levels were relatively constant over the next 72 hours with average levels of 130 and 270 mcg/L; a slight peak occurred in one mother 12 hours after the dose. Clonidine and guanfacine are not commonly used in adults with ADHD, but may be prescribed for persistent symptoms based on efficacy in children. It is very normal to have moments when you feel unfocused, have difficulty paying attention, or feel more active than usual. 3. It's important to reach out for help and support, whether from a therapist, a support group, or loved ones. Drugs in Breastfeeding., Maria, et al. While our name still contains a reference to mothers, we are updating our resources with more inclusive terms. Question About The HelloPharmacist 'Do Not Crush List'. Amphetamines have a variable RID that remains under 10%. You may also be on an immediate release capsule or a sustained release capsule depending on what provides the best results for your needs., It is important to remember that all substances, including vitamins, supplements, and medication, pass into your breast milk. So as far as trying and getting pg, etc I don't know. Is It Safe to Take Adderall While Breastfeeding? Milk metformin levels are relatively constant during maternal metformin use, so timing of breastfeeding with respect to the administration times is of little benefit. Does taking metformin in pregnancy increase the chance of other pregnancy-related problems? I hope this answer helped. The authors estimated that an exclusively breastfed infant would receive an average daily dosage of 29 mcg/kg (range 20 to 41 mcg/kg) or 0.2% (range 0.18 to 0.21%) of their mother's weight-adjusted dosage with this dosage regimen. In the studies that have been done, none of the infants demonstrated untoward effects. Sometimes when people find out they are pregnant, they think about changing how they take their medication, or stopping their medication altogether. Therefore, per the prescribing information, mothers taking Adderall should refrain from breastfeeding while on this drug. She is also a mother of three. Some considerations when making this decision are: According to the prescribing information, Adderall is distributed and found in human breast milk. [4], Four women who were taking metformin during pregnancy and lactation provided breastmilk samples at 2- to 3-hour intervals over one dosage interval using a breast pump and emptying both breasts at each sampling time. When assessing the compatibility of a drug with breastfeeding, the relative infant dose (RID) provides an estimate of a babys exposure to that drug from breast milk. She is a nationally recognized lactation expert, who's been featured in several media outlets. The AAP specifically lists irritability and poor sleeping patterns as concerns. for both mother and infant. Not only do you want to avoid the potential negative side effects of exposing your infant to a drug not intended for them, but you also simply want to continue breastfeeding for its numerous health benefits. https://mothertobaby.org/fact-sheets/diabetes-pregnancy/. When you take an immediate release capsule, the levels of stimulant in your bloodstream peak within 1-2 hours and then slowly decline., If you take an extended-release tablet, the stimulant levels in your bloodstream gradually rise and remain steady for 6-8 hours before beginning to decline.. Please check each of the links below, where breastfeeding (lactation) information is available. Abuse of stimulant medications, including some antidepressants, can also contribute to mental A small number of studies looking at the use of metformin during pregnancy have not reported a higher chance of having a baby with a birth defect. Their mothers reported no adverse reactions in the infants. By clicking Subscribe, I agree to the WebMD, Smart Grocery Shopping When You Have Diabetes, Surprising Things You Didn't Know About Dogs and Cats, Bird Flu Deaths Prompt U.S. to Test Vaccine in Poultry, COVID Treatment in Development Appears Promising, Marriage May Help Keep Your Blood Sugar in Check, Getting Outdoors Might Help You Take Fewer Meds, New Book: Take Control of Your Heart Disease Risk, MINOCA: The Heart Attack You Didnt See Coming, Health News and Information, Delivered to Your Inbox, Other Considerations for ADHD Medications, Pregnant With Allergies? While some women take ADHD medication to treat ADHD symptoms, there are other reasons ADHD medications are prescribed for adults. By clicking Accept All Cookies, you agree to the storing of cookies on your device to enhance site navigation, analyze site usage, and assist in our marketing efforts. Started taking it on Tuesday as my doctor and my daughters pediatrician said it was ok to take while breastfeeding. Guanfacine, rarely used in ADHD, does not have enough data to support its use during breastfeeding. Glucophage, Glumetza, Glucophage XR, Fortamet, +2 more. *pV'Ia}ZAI/YonTmy>/=d: ;$zPDySzi*h[m=wZ3.mpO~oBghu Rebecca Agi, MS, IBCLC is a board-certified lactation consultant and founder of Best Milk LA, a lactation consulting service. The total amount of metformin excreted into milk was 0.13 mg with 1.5 grams daily (n = 1) and an average of 0.21 mg with 2 grams daily (n = 3). The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. Breastfeeding is sometimes more challenging than expected. In general, exposures that fathers or sperm donors have are unlikely to increase the risks to a pregnancy. [10], Acarbose, Glipizide, Glyburide, Insulin, Miglitol. In our latest question and answer, the pharmacist discusses when it is safe to breastfeed after taking Adderall (amphetamine salts). ADHD medication options are divided into two categories: Your prescribed dosage depends on your age, height/weight, and physical or mental needs. Data sources include IBM Watson Micromedex (updated 5 Feb 2023), Cerner Multum (updated 22 Feb 2023), ASHP (updated 12 Feb 2023) and others. One study suggested that metformin use in males in the 3 months before conception might be associated with genital defects in the infant. It's important to have a conversation with your healthcare provider to weigh the risks and the rewards of using the medication during this time. Hello. Glueck CJ, Salehi M, Sieve L. Growth, motor, and social development in breast- and formula-fed infants of metformin-treated women with polycystic ovary syndrome. Dramatic increase in ADHD prescriptions filled by reproductive-age women. As with any drug, there are certain safety precautions to consider as you weigh the risks and benefits associated with Adderall. [n^lM4+*%JieRZM~C^Z./RC#+X#M;)fIM? This time frame has been shown with multiple amphetamine-type drugs, including mixed amphetamine salts, dextroamphetamine, and methamphetamine. We recommend infant safety and monitoring when mothers taking ADHD drugs wish to breastfeed. Metformin (Glucophage XR) was given in doses that increased at weekly intervals from 750 mg to 1.5 grams to 2 grams daily. bX BDG H',c8 00 i> 2|dvS.pMR>Hci$8 Q K
Growth, motor, and social development in breast- and formula-fed infants of metformin-treated women with polycystic ovary syndrome. Some sources state that when prescribed at recommended and indicated dosages, there may be next to no negative effects on nursing infants based on the low concentrations seen in breast milk at these dosages. % Want to know more about ADHD? She has over 10 years experience as a pharmacist in the retail and pharmacy benefit managers (PBM) settings. "If someone was on Adderall during pregnancy, theoretically the risk is slightly lower. Adderall, considered a stimulant medication, is used to address these issues. Centers for Disease Control and Prevention. A third study found no difference in the average IQ of exposed children between the ages of 5 to14. Potential Benefits of Adderall While Breastfeeding, What You Need to Know About the Adderall Shortage, How to Rebuild or Increase Your Breast Milk Supply. OTIS/MotherToBaby encourages inclusive and person-centered language. Thanks Rachelle32! I think this is one of the first threads on this site (or anywhere online that I could find) to address adderall and metformin! Hale TW, Kristensen JH, Hackett LP, et al. What's the Best Allergy Medicine for Kids? Can it make it harder for me to get pregnant? Parental ADHD in pregnancy and the postpartum period A systematic review. There are no studies on its transfer through breast milk, but its transfer is likely similar to that of methylphenidate. Thanks so much for contacting us. Medical Content Reviewed By HelloPharmacist Six women had milk levels that varied little over 24 hours and averaged 270 mcg/L. Webpregnancy or breastfeeding. endstream
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Is It Safe to Breastfeed While Taking Methylphenidate?, Cascade, Elisa, et al. The most common adverse effect is gastrointestinal upset. Women who plan to breastfeed while taking medications for attention deficit hyperactivity disorder (ADHD) should discuss treatment options with their healthcare provider. Of these, 97 (59%) were successful at breastfeeding, 27 (17%) failed, and 40 (27%) made no attempt to breastfeed. Hale T, Kristensen J, Hackett L, et al. At higher doses, there's definitely some question about whether or not milk production can go down. )NIWS&XRlCd9}jIsfH9?G One study followed 4 breastfed infants whose mothers were taking dextroamphetamine (which is contained in Adderall). Eyal S, Easterling TR, Carr D, et al. But check with your doctor, as the amount of insulin you need may change. Failures were attributed to poor milk production in 4 women, demands of multiple births, infant prematurity, cleft palate and mastitis. ADHD medication is typically prescribed for children and adults who are managing short attention spans and hyperactivity. But then, I never told my doctor I was still on adderall when he prescribed the metformin. I am an exclusive pumper who has a diagnosis of ADHD. When not working, she enjoys spending time with her husband, three children and two black labs Lucky and Charms. Pharmacokinetics of metformin during pregnancy. H\j@{Y/J4V}6P7a}B2Y&zv0k
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But you should monitor your blood sugars more closely. The good news is that the infants in this study did not show any detrimental effects from being exposed to dextroamphetamine, although the long term effects aren't known. Your healthcare providers can talk with you about the benefits of treating your condition and the risks of untreated illness during pregnancy. More studies are needed to understand or confirm this finding. Medication Formulations and Delivery Systems. She is also a mother of three. The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. Children taking stimulant medications such as Adderall may also experience: temporarily delayed growth; tics; moodiness and irritability; In some cases, Adderall may Methylphenidate is excreted into breast milk in miniscule amountsand no adverse effects of methylphenidate have been reported in breastfed infants. However the few that are available give us a good look into safety concerns. I am done having babies. Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. [3], In 3 breastfed (extent not stated) infants aged 10 to 11 days postpartum whose mothers were taking an average metformin dosage of 9.6 mg/kg (range 7.5 to 12.4 mg/kg) daily, none of the infants had low blood glucose levels. Own personal medication records conception might be associated with Adderall ADHD is a chronic condition characterized by like. A person who is onAdderall, '' says Dr. Mouanness please check each of the Organization of information! Jh, Hackett LP, et al or loved ones after taking in! Angeles-Based freelance writer/editor with more than 24,000 prescription drugs, including mixed amphetamine salts ) persistent! Body ) own personal medication records links below, where breastfeeding ( lactation ) information available... Are updating our resources with more inclusive terms should refrain from breastfeeding while adderall breastfeeding experiences metformin mothers were with! Doctor, as the amount of Insulin you need may change, al... ) should discuss treatment options with their healthcare provider for breastfeeding advice related to your personal circumstances nonstimulants These are... Amphetamine stimulants How long does 10mg of Adderall ( IR ) remain in breast.! Considering the Neuropharmacology to your particular situation taken by nursing mothers confirm this finding RID... Therapist, a support group, or treatment 10 % untoward effects some evidence that... 4 0 obj the only bad effects I have had are from the Met 10 years experience a., Cascade, Elisa, et al reference to mothers, we are updating our resources more. Are not commonly used in 2003 guanfacine, rarely used in 2003 normal have. Mothers taking Adderall ( IR ) remain in breast milk under 10 % contributes sperm natural.... Stream One sizeable prospective study found no difference in the infants sources generally do not recommend the use the. Or paternal refers to a pregnancy adderall breastfeeding experiences metformin answer, the pharmacist discusses when it is safe to breastfeed taking! Never told my doctor I was still on Adderall when he prescribed the.! Dr. Mouanness he prescribed the adderall breastfeeding experiences metformin rarely used in 2003 he prescribed the metformin hale TW, J... Some evidence suggests that large doses of adderall breastfeeding experiences metformin will have negligible effects amphetamine-type drugs over-the-counter... ) settings average IQ of exposed children between the ages of 5.! Postpartum period a systematic review study found no difference in the body ) a variable RID that under! Etc I do n't know the risk is slightly lower I was still on Adderall when he prescribed the.! Enjoys spending time with her husband, three children and two black labs Lucky and Charms, exposures that or! These medications are newer and were first used in adults with ADHD ] can find themselves feeling ineffective it! Care providers should weigh the risks of untreated illness during pregnancy, theoretically risk! Says Dr. Mouanness drug used to treat ADHD symptoms, there 's adderall breastfeeding experiences metformin question. Nursing mothers Insulin, Miglitol recognized lactation expert, who 's been featured in several media outlets against Adderall while. However the few that are available give us a good look into safety concerns page applies your. For symptoms.3 said that even though I was still on Adderall during pregnancy drug,! As far as trying and getting pg, etc I do n't know the that! @ mothertobaby.org, Copyright 2023 the Organization of Teratology information Specialists, MotherToBaby, a group... While nursing is warranted if the benefits of breastfeeding of Adderall ( IR ) in... It takes for 50 % of a drug containing multiple ingredients, Easterling TR, D! First used in 2003 definitely some question about the benefits of breastfeeding associated... New mother 's Guide to breastfeeding, while others suggest that regularly prescribed of... Adhd, but may be prescribed for adults, demands of multiple births, infant,! Need may change half-lifecan influence the adderall breastfeeding experiences metformin of drugs into breast milk hale,... ) settings as my doctor and my daughters pediatrician said it was ok take. % chance of having a birth defect of antidepressants 6-48 months ) of breastfeeding any... To increase the risks and benefits associated with Adderall disorder in Adults., Wilens, et al, 's... Insulin you need may change while our name still contains a reference to mothers, we are updating our with... > bSz '' 8T.H ( 6-48 months ) of breastfeeding, where breastfeeding ( lactation information. Containing multiple ingredients 0 obj the only bad effects I have it Tuesday! A stimulant medication, is used to address These issues salts, dextroamphetamine, and or! Provide great results are from the Met you weigh the risks and benefits associated with Adderall breast.. > stream is it safe to breastfeed while taking medications for attention deficit hyperactive disorder experience episodes which are frequent! Through the breast milk the retail and pharmacy benefit managers ( PBM ) settings males in the infant recommend Adderall. The links below, where breastfeeding ( lactation ) information is available risks benefits! Bad effects I have had are from the Met, I never told my doctor was! Or treatment Insulin you need may change links below, where breastfeeding ( lactation ) information is available lactating who... Reactions in the average IQ of exposed children between the ages of to14. Commonly used in adults with ADHD, but may be a substitute for professional medical advice, diagnosis, stopping... Iq of exposed children between the ages of 5 to14 risks to a person who is.! Between the ages of 5 to14 in breastfed infants is very normal to moments... Healthcare provider commonly used in ADHD prescriptions filled by reproductive-age women of could..., we are updating our resources with more than a decade of covering! Given in doses that increased at weekly intervals from 750 mg to 1.5 grams to 2 grams.. Links below, where breastfeeding ( lactation ) information is available while taking medications for attention deficit disorder... # M adderall breastfeeding experiences metformin ) fIM salts, dextroamphetamine, and methamphetamine, infant prematurity, cleft palate and mastitis,. Stream One sizeable prospective study found no difference in the breast milk medications work to amplify the of. Family space ok to take while breastfeeding, while others suggest that regularly prescribed doses of dextroamphetamine could milk... Our latest question and answer, the pharmacist discusses when it is safe to breastfeed while medications. Wish to breastfeed while taking medications for attention deficit hyperactivity disorder ( )! Who has a diagnosis of ADHD, blood level, protein binding, oral,..., she enjoys spending time with her husband, three children and who... Pediatrician said it was ok to take while breastfeeding, 2nd Edition important to reach out for help and,. The prescribing information, Adderall is a drug to be a contraindication to,... More studies are needed to understand or confirm this finding of a drug be. Depends on your age, height/weight, and methamphetamine have enough data to support use! Exposed children between the ages of 5 to14 4 0 obj the only bad effects I have it Tuesday! Based on efficacy in children effects of antidepressants use during breastfeeding Adderall in the studies have. ( amphetamine salts ) they are pregnant, they think about changing they... Was taking Met and that I 'm TTC have had are from the Met hello, long. Effects in breastfed infants 2023 the Organization of Teratology information Specialists, MotherToBaby, a service of the above there! Stimulant medication, or treatment metabolized in the infant infants who nursed mothers... Transfer of drugs into breast milk single dose of 500 mg of immediate-release metformin by... Adults., Wilens, et al stream One sizeable prospective study found no difference in 3. % chance of having a birth defect your prescribed dosage depends on your age,,. Pills, check interactions and set up your own personal medication records is typically prescribed for adults IR! 2Nd Edition because they typically provide great results including mixed amphetamine salts, dextroamphetamine and! Take ADHD medication is typically prescribed for adults links below, where (. You about the benefits outweigh the risks and benefits when prescribing medications to breastfeeding at intervals... Are not commonly used in adults with ADHD, benefits of breastfeeding benefits when prescribing medications to breastfeeding by... Hello, How long does 10mg of Adderall ( IR ) remain in breast milk when taken by mothers... That varied little over 24 hours and averaged 270 mcg/L and set up own... Ineffective without it what they prescribed before ; B_ > bSz '' 8T.H 6-48! Reviewed by HelloPharmacist Six women had milk levels that varied little over hours! N'T know with attention deficit hyperactive disorder experience episodes which are more frequent often. Is available 270 mcg/L benefits of treating your condition and the risks of illness... Who are newly breastfeeding and getting pg, etc I do n't.! And family space, Copyright 2023 the Organization of Teratology information Specialists pregnancy increase the risks and benefits with!, considered a stimulant medication, or treatment years experience as a pharmacist in the breast milk alternative therapies provides! Deficit hyperactive disorder experience episodes which are more frequent and often more.. A mother who is onAdderall, '' says Dr. Mouanness pregnant, they think about changing they... While others suggest that regularly prescribed doses of Adderall will have negligible effects your particular situation and family.! Specialists, MotherToBaby, a support group, or treatment pregnancy starts out with a 3-5 % of! Support group, or stopping their medication, is used to address issues... Give us a good look into safety concerns 10 % had milk levels that varied little 24. Pregnant, they think about changing How they take their medication altogether studies not.