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ADHD Medication During Pregnancy and Breastfeeding The decision to stop or continue ADHD medications during pregnancy and breastfeeding is challenging for women with the condition. There isn't much information on how long-term exposure to these drugs could affect the foetus. A study recently published in Molecular Psychiatry demonstrates that children exposed to ADHD medication during pregnancy do not develop neurological disorders such as hearing loss or vision, febrile seizures or IQ impairment. medications for adhd in adults acknowledge that further high-quality research is needed. Risk/Benefit Analysis Women who are expecting and taking ADHD medication should weigh the benefits of taking it versus the risks to the baby. Physicians don't have the data to make unambiguous recommendations but they can provide information on the risks and benefits to help pregnant women make informed decisions. A study published in Molecular Psychiatry concluded that women who took ADHD medication during early pregnancy were not at a higher risk of fetal malformations or structural birth defects. Researchers conducted a large sample-based case control study to examine the prevalence of major structural defects in infants who were born to mothers who took stimulants during pregnancy. Clinical geneticists, pediatric cardiologists and other experts reviewed the cases in order to make sure that the classification was accurate and to eliminate any bias. However, the study had its limitations. The most important issue was that they were unable to distinguish the effects of the medication from those of the disorder that is underlying. This limitation makes it difficult for researchers to determine whether the few associations observed between the groups that were exposed to medication use, or if they were confounded by co-morbidities. Researchers also did not study long-term outcomes for offspring. The study did find that babies whose mothers had taken ADHD medication during pregnancy were at a more risk of being admitted to the neonatal intensive care unit (NICU) than those who were born without any medication or had stopped their medications before or during pregnancy. This was due to central nervous system disorders. The increased risk of admission was not influenced by the stimulant medications used during pregnancy. Women who took stimulant ADHD medications during pregnancy also had a higher chance of having to have an emergency caesarean section or having a baby that scored low on the Apgar scale (less than 7). These increases didn't appear to be influenced by the type of medication that was used during pregnancy. Researchers suggest that the small risk of using ADHD medication during pregnancies in the early stages could be offset by the more beneficial outcomes for both mother and baby of continuing treatment for the woman's condition. Physicians should discuss this with their patients and, when possible, assist them in developing strategies for improving their coping skills that can lessen the effects of her disorder on her daily functioning and relationships. Interactions with Medication As more women than ever are being diagnosed with ADHD and treated with medication, the dilemma of whether to continue or discontinue treatment during pregnancy is one that more and more doctors confront. These decisions are frequently made without clear and authoritative evidence. Instead, doctors must weigh their own knowledge in conjunction with the experiences of other physicians and the research on the subject. The issue of possible risks to the infant can be particularly tricky. Many of the studies on this topic are based on observations instead of controlled research and their findings are often contradictory. Most studies focus on live births, which can underestimate the severity of teratogenic effects leading to terminations or abortions of pregnancy. The study discussed in this journal club addresses these shortcomings by looking at data from both live and deceased births. Conclusion A few studies have revealed a positive correlation between ADHD medications and certain birth defects, other studies have not shown such a relationship. Most studies show an unintended, or somewhat negative, effect. In every case, a careful study of the benefits and risks should be conducted. For a lot of women with ADHD, the decision to discontinue medication is difficult if not impossible. 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 lead to increased depression, feelings of loneliness and family conflict for those suffering from the disorder. A decrease in medication could also affect the ability to safely drive and perform work-related tasks, which are essential aspects of everyday life for those with ADHD. She suggests that women who are not sure whether to continue taking medication or stop it due to their pregnancy should educate family members, coworkers and friends about the condition, its impact on daily functioning and the benefits of continuing the current treatment plan. In addition, educating them can aid in ensuring that the woman feels supported in her struggle with her decision. Certain medications can pass 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 medication could be passed on to her baby. Birth Defects Risk As the use of ADHD medications to treat symptoms of attention deficit hyperactivity disorder (ADHD) grows, so do concerns about the effects that the drugs could have on fetuses. Recent research published in the journal Molecular Psychiatry has added to the body of knowledge regarding this issue. Utilizing two huge data sets researchers were able to analyze more than 4.3 million pregnancies to determine whether 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 increase in the risk of certain heart defects, like ventriculo-septal defects (VSD). The authors of the study found no connection between early medication use and congenital abnormalities such as facial clefting or club foot. The findings are in line with previous studies showing the presence of a small, but significant increase in the risk of heart malformations among women who began taking ADHD medications before pregnancy. The risk was higher during the latter part of pregnancy, when many women begin to discontinue their ADHD medication. Women who took ADHD medications in the first trimester of their pregnancies were also more likely to experience caesarean sections, a low Apgar score after delivery and a baby who required help breathing at birth. The researchers of the study were not able to eliminate selection bias because they limited the study to women who did not have any other medical conditions that might have contributed to the findings. The researchers hope that their research will serve to inform the clinical decisions of doctors who see pregnant women. They recommend that, while a discussion of the benefits and risks is important, the decision to stop or keep medication should be based on each woman's requirements and the severity of her ADHD symptoms. The authors also warn that, while stopping the medication is an option, it is not an option to consider due to the high prevalence of depression and other mental health issues among women who are pregnant or postpartum. Research has also shown that women who stop taking their medication will have a harder adjustment to life without them after the baby is born. Nursing The responsibilities that come with being a new mother can be overwhelming. Women who suffer from ADHD who have to manage their symptoms while attending doctor appointments as well as getting ready for the arrival of their child and adapting to new routines in the home can experience severe challenges. Many women choose to continue taking their ADHD medication during pregnancy. The majority of stimulant medicines are absorbed through breast milk in low quantities, so the risk to breastfeeding infant is minimal. However, the frequency of exposure to medications by the newborn can vary depending on the dosage, frequency it is taken and the time of day it is administered. Additionally, different medications enter the baby’s system via the gastrointestinal tract or through breast milk. The impact on the health of a newborn isn't completely known. Due to the absence of research, some physicians may recommend stopping stimulant medications during the pregnancy of a woman. It's a difficult choice for the mother, who must weigh the benefits of taking her medication as well as the risk to the foetus. As long as more information is available, doctors may inquire about pregnant patients whether they have an background of ADHD or if they plan to take medication during the perinatal stage. A growing number of studies have proven that women can continue their ADHD medication while they are pregnant and nursing. This has led to an increasing number of patients opt to do this and, in consultation with their physician, they have found that the benefits of keeping their current medication outweigh any potential risks. It is crucial for women suffering from ADHD who are thinking of breastfeeding to seek out a specialist psychiatrist's guidance prior to becoming pregnant. They should review their medications with their doctor and discuss the advantages and disadvantages of continued treatment, including non-pharmacological strategies. Psychoeducation should also be provided to help pregnant people with ADHD be aware of their symptoms and the root cause and learn about treatments and to reinforce existing strategies for managing. This should be an approach that is multidisciplinary, including the GP, obstetricians and psychiatry. Pregnancy counselling 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 the need for adjustments to the medication regimen.