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ADHD Medication During Pregnancy and Breastfeeding The decision to stop or continue ADHD medication during pregnancy and nursing is a difficult decision for women suffering from the condition. There isn't much information on how long-term exposure to these drugs may affect the foetus. A recent study published in Molecular Psychiatry demonstrates that children exposed to ADHD medication during pregnancy do not develop neurological issues such as impaired hearing or vision, febrile seizures, or IQ impairment. The authors acknowledge the need for more high-quality research. Risk/Benefit Analysis Women who are pregnant and taking ADHD medications need to balance the advantages of taking them against potential risks to the fetus. Physicians don't have the data to give clear advice however they can provide information on risks and benefits to assist pregnant women to make informed choices. A study published in Molecular Psychiatry concluded that women who were taking ADHD medication in early pregnancy were not at a greater risk of fetal malformations or structural birth defects. Researchers used a large population-based study of case control to compare the incidence of structural defects that were major in infants born to mothers who were taking stimulants during pregnancy. Clinical geneticists and pediatric cardiologists reviewed the cases to ensure correct classification of the cases and to reduce the possibility of bias. However, the researchers' study had its limitations. Researchers were unable, in the first place to differentiate the effects caused by the medication from the disorder. This limitation makes it difficult for researchers to determine if the small associations observed among the groups exposed were due to the use of medications or caused by co-morbidities. Researchers also did not study the long-term effects for the offspring. The study did find that infants whose mothers had taken ADHD medications during pregnancy were at a higher risk of being admitted to the neonatal intensive care unit (NICU) than infants whose mothers had not taken any medication or stopped their medications before or during pregnancy. The reason for this was central nervous system disorders. The higher risk of admission was not influenced by the stimulant medication that was used during pregnancy. Women who took stimulant ADHD medications during pregnancy also had a higher likelihood of having to have a caesarean section or the baby was not scoring well on the Apgar scale (less than 7). These increases didn't appear to be affected by the type of medication that was used during pregnancy. The research suggests that the small risk associated with the use of ADHD medications during the early stages of pregnancy could be offset by the greater benefit for both mother and child from continued treatment for the woman's disorder. Physicians should talk to their patients about this issue and, if possible, help them develop coping strategies that could reduce the effects of her disorder on her daily life and relationships. Medication Interactions More and more doctors are confronted with the dilemma of whether to maintain treatment or stop it during pregnancy as more women are diagnosed with ADHD. These decisions are often made without clear and authoritative evidence. Instead, doctors must weigh their own knowledge in conjunction with the experiences of other doctors and the research on the topic. Particularly, the issue of potential risks to the baby can be a challenge. A lot of studies on this issue are based on observational evidence rather than controlled research, and their conclusions are often contradictory. The majority of studies limit their analysis to live births, which can underestimate the severity of teratogenic effects that can lead to terminations or abortions of pregnancy. The study discussed in this journal club addresses these shortcomings by examining data on both live and deceased births. The conclusion: While some studies have found that there is a positive correlation between ADHD medications and the risk of certain birth defects, other studies have found no such relationship, and most studies have a neutral or slightly negative impact. As a result, a careful risk/benefit assessment must be conducted in every case. For a lot of women with ADHD who suffer from 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 lead to increased depression, feelings of isolation, and family conflict for these patients. A loss of medication may also impact the ability to drive safely and to perform work-related tasks which are crucial aspects of everyday life for people with ADHD. She suggests women who are uncertain about whether or not to stop medication in light of their pregnancy should consider educating family members, friends and colleagues on the condition, its effects on daily functioning, and on the advantages of staying on the current treatment plan. It can also help a woman feel supported in her decision. Certain medications can pass through the placenta. If a woman decides not to take her ADHD medication while pregnant and breastfeeding, it's important to be aware that the drug may be transferred to her infant. Risk of Birth Defects As the use and abuse of ADHD medications to treat the symptoms of attention deficit disorder hyperactivity disorder (ADHD), increases as does the concern about 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 topic. Researchers used two massive datasets to analyze over 4.3 million pregnancies and determine if the use of stimulant medications increased birth defects. While the overall risk is low, the researchers did find that first-trimester exposure to ADHD medications was linked to a slightly higher rate of specific heart defects, such as ventriculoseptal defect (VSD). The researchers behind the study found no link between the use of early medications and other congenital anomalies, such as facial clefting or club foot. The results are in line with previous studies revealing the presence of 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. The risk increased in the latter stages of pregnancy, when a lot of women stopped taking their medication. Women who took ADHD medication in the first trimester were more likely to require a caesarean delivery, have a low Apgar after birth and have a baby that needed breathing assistance when they were born. However the authors of the study were unable to eliminate bias due to selection by limiting the study to women who didn't have any other medical issues that could have contributed to these findings. The researchers hope their study will help inform the clinical decisions of physicians who treat pregnant women. They suggest that although discussing the risks and benefits is crucial however, the decision to stop or keep treatment must be based on each woman's requirements and the severity of her ADHD symptoms. The authors caution that, even though stopping the medication is an option to look into, it is not advised because of the high incidence of depression and mental health issues among women who are pregnant or recently gave birth. Further, the research suggests that women who choose to stop taking their medications are more likely to have difficulties getting used 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 can face severe challenges when they must manage their symptoms, attend doctor appointments and prepare for the birth of their child and adjust to a new routine. Therefore, many women decide to continue taking their ADHD medications throughout the course of pregnancy. The majority of stimulant drugs are absorbed through breast milk in low amounts, therefore the risk for breastfeeding infant is minimal. However, the frequency of exposure to medication by the infant can differ based on the dosage, frequency it is taken and the time of the day the medication is administered. Additionally, different medications enter the infant's system differently through the gastrointestinal tract and breast milk, and the effect of this on a newborn is not yet fully known. adhd medication for adults to the absence of research, some doctors may be inclined to discontinue stimulant drugs during a woman's pregnancy. This is a difficult decision for the mother, who must weigh the advantages of her medication against the potential risks to the fetus. In the meantime, until more information is available, GPs should ask all pregnant patients about their experience with ADHD and if they are taking or planning to take medication during the perinatal period. A increasing number of studies have proven that the majority of women are able to safely continue taking their ADHD medication during pregnancy and while breastfeeding. In response, an increasing number of patients are choosing to do this. They have concluded after consulting with their doctors that the benefits of retaining their current medication far outweigh any possible risks. Women who suffer from ADHD who are planning to nurse should seek the advice of 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 methods. Psychoeducation should also be offered to help women with ADHD recognize their symptoms and the underlying disorder, learn about available treatment options and strengthen existing strategies for coping. This should be a multidisciplinary process with the GPs, obstetricians, and psychiatry. The pregnancy counselling should consist of the discussion of a plan for management for both the mother and child, and monitoring for signs of deterioration, and, if necessary, adjustments to the medication regimen.