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ADHD Medication During Pregnancy and Breastfeeding Women with ADHD have to make a difficult choice regarding whether or not to stop taking ADHD medication during pregnancy and breast-feeding. There are few data on how long-term exposure may affect a fetus. A study recently 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 that more high-quality studies are needed. Risk/Benefit Analysis Pregnant women who use ADHD medications need to balance the advantages of taking them against potential risks to the foetus. Doctors don't have enough data to provide clear recommendations, but can provide information on the risks and benefits to aid pregnant women in making an informed decision. A study published in Molecular Psychiatry found that women who were taking ADHD medications during early pregnancy did not face an increased risk of fetal cardiac malformations or major birth defects that are structural. Researchers conducted a large population-based case-control study to assess the risk of major structural birth defects in infants born to mothers who had taken stimulants in early pregnancy and those who had not. Pediatric cardiologists, clinical geneticists and other experts examined the cases to make sure that the classification was correct and to eliminate any bias. The research conducted by the researchers had some limitations. In particular, they were unable to separate the effects of the medication from the disorder that is underlying. This limitation makes it difficult for researchers to determine if the small associations observed among the groups exposed were due to medication use or affected by co-morbidities. Researchers also did not study long-term outcomes for the offspring. The study showed that infants whose mothers had taken ADHD medication during pregnancy were at a slightly greater risk of being admitted to the neonatal care unit (NICU), compared to mothers who did not take any medication during pregnancy or had stopped taking their medication before or during pregnancy. This was due to central nervous system disorders, and the increased risk of admission was not found to be influenced by which stimulant medications were taken during pregnancy. Women who used stimulant ADHD medication during pregnancy were also at an increased chance of having a caesarean birth or having a baby with low Apgar score (less than 7). These increases didn't seem to be influenced by the kind of medication used during pregnancy. Researchers suggest that the small risks posed by the use of ADHD medications during early pregnancies may be offset by the greater benefits to both mother and baby of continuing treatment for the woman’s disorder. Physicians should talk to their patients about this issue and try to help them develop coping strategies that could reduce the effects of her disorder on her daily functioning and her relationships. Medication Interactions As more women than ever are diagnosed with ADHD and treated with medication, the dilemma of whether to continue or stop treatment during pregnancy is one that more and more doctors confront. These decisions are frequently made without clear and authoritative evidence. Instead, physicians must weigh their own knowledge, the experience of other doctors, and the research on the topic. Particularly, the subject of potential risks to the infant can be difficult. The research that has been conducted on this topic is based on observation instead of controlled studies and a lot of the results are conflicting. The majority of studies limit their analysis to live births, which may underestimate the severity of teratogenic effects leading to terminations or abortions of pregnancy. The study that is discussed in the journal club addresses these issues by analyzing data on live and deceased births. Conclusion A few studies have revealed a positive correlation between ADHD medications and certain birth defects However, other studies haven't shown such a relationship. Most studies show an unintended, or slight negative effect. In the end, a careful risk/benefit assessment must be done in each instance. It can be difficult, if not impossible, for women with ADHD to stop taking their medication. 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 cause depression, feelings of isolation, and family conflict for these patients. Furthermore, a loss of medication can interfere with the ability to perform jobs and drive safely which are essential aspects of daily life for many people with ADHD. She suggests that women who are not sure whether to take the medication or stop it due to their pregnancy educate family members, coworkers, and acquaintances about the condition, its effects on daily functioning, and the benefits of keeping the current treatment plan. It will also help a woman feel more confident in her decision. Some medications can pass through the placenta. If a patient decides not to take her ADHD medication while pregnant and breastfeeding, it's important to be aware that the drug could be transferred to the baby. Risk of Birth Defects As the use and abuse of ADHD drugs to treat symptoms of attention deficit hyperactivity disorder (ADHD) increases the concern over the potential adverse effects of the drugs on foetuses. A recent study published in the journal Molecular Psychiatry adds to the existing information on this topic. Researchers used two massive data sets to examine over 4.3 million pregnancies and determine if stimulant medication use caused birth defects. Although the risk overall remains low, the researchers did find that first-trimester exposure to ADHD medications was associated with an increase in the risk of certain heart defects, like ventriculo-septal defects (VSD). The authors of the study found no link between the use of early medications and congenital abnormalities such as facial clefting or club foot. The results are in agreement with previous studies that have shown the existence of a slight, but significant increase in the number of cardiac malformations among women who began taking ADHD medication prior to pregnancy. This risk increased during the latter stages of pregnancy when a large number of women stopped taking their medication. Women who took ADHD medications in the first trimester of pregnancy were also more likely to undergo caesarean section, low Apgar score after delivery and a baby who needed breathing assistance at birth. adult adhd treatments I Am Psychiatry of the study could not remove bias in selection since they restricted the study to women without other medical conditions that might have contributed to the findings. Researchers hope that their research will provide doctors with information when they meet pregnant women. The researchers advise that while discussing risks and benefits are crucial, the decision on whether to continue or stop taking medication should be in light of the severity of each woman's ADHD symptoms and the needs of the woman. The authors warn that, while stopping the medication is a possibility to consider, it is not advised due to the high prevalence of depression and other mental disorders for women who are pregnant or recently gave birth. Furthermore, research suggests that women who decide to stop their medications are more likely to experience difficulties adapting to life without them following the birth of their baby. Nursing The responsibilities of a new mom can be overwhelming. Women with ADHD who must work through their symptoms while attending doctor appointments and making preparations for the arrival of a baby and adapting to new routines in the home may face a lot of challenges. Many women decide to continue taking their ADHD medication during pregnancy. The majority of stimulant drugs are absorbed through breast milk in small quantities, so the risk to the breastfeeding infant is minimal. The rate of medication exposure will differ based on dosage the medication is administered, its frequency and the time of the day. Additionally, individual medications enter the body of the baby differently through the gastrointestinal tract and breast milk. The impact of this on a newborn is not yet fully understood. Because of the lack of evidence, some doctors may be inclined to discontinue stimulant drugs during the course of pregnancy. This is a difficult choice for the patient, who must balance the benefits of keeping her medication against the possible dangers to the foetus. In the meantime, until more information is available, doctors should inquire with all pregnant patients about their experience with ADHD and whether they are planning or taking to take medication during the perinatal time. Numerous studies have demonstrated that women can continue to take their ADHD medication in a safe manner while breastfeeding and during pregnancy. In the end, many patients are choosing to do so and, after consulting with their doctor, they have found that the benefits of maintaining their current medication far outweigh any risks. Women with ADHD who are planning to nurse should seek the advice of an expert psychiatrist prior to becoming pregnant. They should discuss their medication with their physician and discuss the advantages and disadvantages of continued treatment, including non-pharmacological strategies. Psychoeducation is also required to help pregnant women with ADHD recognize the signs and underlying disorder. They should also be informed about treatment options and reinforce coping mechanisms. This should involve a multidisciplinary approach, which includes the GP as well as obstetricians, psychiatry and obstetricians. Pregnancy counseling should consist of a discussion of a treatment plan for the mother and the child, monitoring of indicators of deterioration, and, if necessary adjustments to the medication regimen.