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ADHD Medication During Pregnancy and Breastfeeding Women with ADHD must make a difficult decision regarding whether or not to stop taking ADHD medication during pregnancy and breast-feeding. Little data exists about how long-term exposure to these drugs could affect the foetus. A recent study published in Molecular Psychiatry shows that children exposed to ADHD medication during the uterus do not develop neurological disorders like impaired vision or hearing seizures, febrile seizures, or IQ impairment. The authors acknowledge that further high-quality research is needed. Risk/Benefit Analysis Pregnant women who use ADHD medications need to balance the advantages of using them against the risks to the foetus. Physicians don't have the data to give clear advice, but can provide information on risks and benefits to help pregnant women make informed choices. A study published in Molecular Psychiatry found that women who used ADHD medications in early pregnancy did not have an increased risk of fetal cardiac malformations or major birth defects that are structural. Researchers conducted a large population-based study of case control to compare the incidence of major structural defects in infants who were born to mothers who used stimulants during pregnancy. Pediatric cardiologists and clinical geneticists looked over the cases to ensure correct case classification and to limit the chance of bias. The research conducted by the researchers was not without its limitations. The researchers were not able in the beginning, to separate the effects of the medication from the disorder. This limitation makes it difficult to know whether the limited associations observed in the exposed groups are due to medication use or confounding by comorbidities. Researchers also did not look at long-term outcomes for the offspring. The study showed that infants whose mothers had taken ADHD medication during pregnancy were at a slightly higher risk of admission to the neonatal care unit (NICU) in comparison to mothers who did not take any medication during pregnancy or had discontinued taking their medication prior to or during pregnancy. add medication adult was due to central nervous system-related disorders, and the increased risk for admission did not appear to be influenced by which stimulant medication was used during pregnancy. Women who took stimulant ADHD medications during pregnancy also had a higher chance of having to have caesarean sections or one whose baby scored low on the Apgar scale (less than 7). These increases did appear to be independent of the type of medication used during pregnancy. Researchers suggest that the minor risks associated with the use ADHD medications in early pregnancies may be offset by the greater benefits for mother and baby of continuing treatment for the woman’s disorder. Physicians should talk to their patients about this and try to help them develop coping skills that may reduce the impact of her disorder in her daily life and relationships. Medication Interactions As more women than ever are diagnosed with ADHD and being treated with medication, the issue of whether to keep or stop treatment during pregnancy is a question that more and more physicians confront. Most of the time, these decisions are taken in the absence of any evidence that is clear and definitive either way, so physicians must weigh what they know, the experiences of other doctors, and what the research says on the topic and their own judgments for each individual patient. The issue of potential risks to infants is extremely difficult. The research on this issue is based on observations rather than controlled studies, and many of the findings are conflicting. Most studies restrict their analysis to live births, which may underestimate the teratogenic impact that can lead to terminations or abortions of pregnancy. The study discussed in the journal club addresses these limitations by analyzing the data from deceased and live births. The conclusion: While certain studies have demonstrated that there is a positive correlation between ADHD medications and the possibility of certain birth defects, others have not found any evidence of a link and the majority of studies demonstrate a neutral or slightly negative effect. As a result an accurate risk-benefit analysis must be conducted in every instance. For women suffering from ADHD and ADD, the decision to stop medication can be difficult, if not impossible. 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 loneliness, and family conflict for these patients. A decrease in medication could also affect the ability to drive safely and complete work-related tasks, which are vital aspects of daily life for people with ADHD. She suggests women who are unsure about whether to continue or discontinue medication due to their pregnancy should consider informing family members, friends and colleagues on the condition, its impact on daily life, and the benefits of keeping the current treatment regimen. It can also help a woman feel confident about her decision. Certain medications can be passed through the placenta. If the patient decides to stop taking her ADHD medication while pregnant and breastfeeding, it's important to be aware that the drug could be transferred to the infant. Birth Defects and Risk of As the use of ADHD medication to treat the symptoms of attention deficit hyperactivity disorder (ADHD) grows, so do concerns about what impact the drugs could have on the fetuses. Recent research published in the journal Molecular Psychiatry has added to the body knowledge on this issue. Using two massive data sets, researchers were able to examine more than 4.3 million pregnancies and determine whether the use of stimulant medications increased the risk of birth defects. Although the risk overall remains low, the scientists did find that first-trimester exposure to ADHD medicines was associated with an increased risk of certain heart defects, like ventriculo-septal defects (VSD). The authors of the study didn't discover any link between the use of early medications and congenital anomalies like facial deformities, or club feet. The results are consistent 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 was higher during the latter part of pregnancy, when many women decide to stop taking their medication. Women who took ADHD medications during the first trimester of their pregnancy were also more likely to have caesarean section, low Apgar score following delivery, and a baby that required breathing assistance at birth. However the authors of the study were not able to eliminate bias due to selection by restricting the study to women who didn't have other medical issues that could be a contributing factor to these findings. Researchers hope their research will help doctors when they meet pregnant women. The researchers recommend that, while discussing risks and benefits are important, the choice on whether to continue or stop medication should be made according to the severity of each woman's ADHD symptoms and her requirements. The authors warn that, even though stopping the medication is a possibility to look into, it is not advised due to the high prevalence of depression and other mental disorders in women who are expecting or have recently given birth. Further, research shows that women who stop taking their medication will have a harder transitioning to life without them after the baby is born. Nursing The responsibilities of a new mother can be overwhelming. Women who suffer from ADHD who have to deal with their symptoms while attending physician appointments, making preparations for the arrival of their child and adjusting to new household routines can experience severe challenges. Many women choose to continue taking their ADHD medication during pregnancy. The majority of stimulant drugs pass through breast milk in low amounts, therefore the risk to nursing infant is very low. The amount of exposure to medications will vary based on the dosage the medication is administered, its frequency and the time of day. Additionally, more.. enter the baby’s system through the gastrointestinal tract or breast milk. The impact of these medications on the health of a newborn is not fully understood. Because of the lack of evidence, some doctors may recommend stopping stimulant medication during the course of pregnancy. This is a difficult decision for the woman who must weigh the advantages of her medication against the risk to the embryo. As long as more information is available, GPs can inquire about pregnant patients whether they have a history of ADHD or if they are planning to take medication in the perinatal stage. A growing number of studies have revealed that the majority of women are able to safely continue to take their ADHD medication during pregnancy and breastfeeding. In response, an increasing number of patients are choosing to do this. They have discovered through consultation with their doctor that the benefits of retaining their current medication outweigh any risk. It is crucial for women suffering from ADHD who are contemplating breastfeeding to seek out a specialist psychiatrist's advice prior to becoming pregnant. They should discuss the medication they are taking with their physician as well as the pros and cons of continuing treatment. This includes non-pharmacological strategies. Psychoeducation should also be provided to help women with ADHD understand their symptoms and underlying disorder Learn about the available treatment options and reinforce existing coping strategies. This should be a multidisciplinary effort together with obstetricians, GPs, and psychiatry. Counselling for pregnancy should include discussion of a management plan for both the mother as well as the child, as well as monitoring for signs of deterioration and when necessary, making adjustments to the medication regimen.