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ADHD Medication During Pregnancy and Breastfeeding The decision to stop or continue ADHD medication during breastfeeding and pregnancy is a challenge for women suffering from the condition. Little data exists about how long-term exposure to these drugs can affect the foetus. A recent study published in Molecular Psychiatry shows that children exposed to ADHD medication in the uterus don't develop neurological developmental disorders like hearing loss or impaired vision seizures, febrile seizures, or IQ impairment. The authors acknowledge that more high quality studies are required. Risk/Benefit Analysis Women who are pregnant and taking ADHD medications must weigh the advantages of using them against the risks to the fetus. The doctors don't have the information to make unambiguous recommendations 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 took ADHD medication during their early pregnancy did not have a higher risk of fetal malformations or structural birth defects. The researchers used a large population-based case-control study to assess the risk of major structural birth defects in infants born to mothers who took stimulants during the early stages of pregnancy, and those who did not. Clinical geneticists and pediatric cardiologists looked over the cases to ensure accurate case classification and to minimize the chance of bias. However, the researchers' study had its limitations. The most important issue was that they were unable to distinguish the effects of the medication from the disorder that is underlying. This makes it difficult for researchers to determine if the small differences observed between the groups that were exposed to medication use, or if they were confounded by comorbidities. Additionally the researchers did not look at the long-term outcomes of offspring. The study showed that infants whose mothers took ADHD medication during pregnancy had a slightly higher chance of being admitted to the neonatal care unit (NICU) as compared to those whose mothers didn't take any medication during pregnancy or stopped taking their medication before or during pregnancy. This increase was caused by central nervous system disorders. The higher risk of admission was not affected by the stimulant medications used during pregnancy. Women who were taking stimulant ADHD medications during pregnancy also had a higher likelihood of having a caesarean section or a baby that scored low on the Apgar scale (less than 7). These increases appeared to be independent of the type of medication used during pregnancy. Researchers suggest that the minor risk of using ADHD medications in early pregnancies may be offset by the greater benefits to both baby and mother of continued treatment for the woman’s disorder. Physicians should talk to their patients about this issue and, if possible, help them develop coping skills that may reduce the impact of her disorder in her daily life and relationships. Medication Interactions More and more doctors are confronted with the dilemma of whether to maintain treatment or stop during pregnancy as more women are diagnosed with ADHD. These decisions are usually taken without clear and authoritative evidence. Instead, doctors have to consider their own expertise in conjunction with the experiences of other doctors and the research that has been conducted on the subject. Particularly, the subject of possible risks to the baby can be tricky. Many studies on this subject are based on observations instead of controlled research and their findings are often contradictory. Furthermore, most studies restrict their analysis to live births, which may underestimate severe teratogenic effects that lead to abortion or termination of the pregnancy. The study discussed in the journal club addresses these shortcomings by analyzing both the data from deceased and live births. Conclusion A few studies have shown a positive correlation between ADHD medications and certain birth defects However, other studies haven't found a correlation. Most studies have shown an unintended, or slightly negative, impact. As a result, a careful risk/benefit analysis must be done in each instance. For women suffering from ADHD who suffer from ADHD, the decision to stop taking medication is difficult, if not impossible. In a recent article in the Archives of Women's Mental Health by psychologist Jennifer Russell, she notes that stopping ADHD medications during pregnancy can lead to depression and feelings of loneliness. Furthermore, a loss of medication can affect the ability to complete jobs and drive safely, which are important aspects of daily life for many people suffering from ADHD. She recommends that women who are unsure about whether or not to stop medication in light of their pregnancy, consider the possibility of educating friends, family members and colleagues about the condition, its effects on daily functioning, and on the benefits of keeping the current treatment plan. In addition, educating them can aid in ensuring that the woman feels supported when she is struggling with her decision. Some medications can pass through the placenta. If a patient decides to stop taking her ADHD medication while pregnant and breastfeeding, it is crucial to be aware that the drug could be transferred to the infant. Risk of Birth Defects As the use of ADHD drugs to treat symptoms of attention deficit hyperactivity disorder (ADHD) increases as do concerns about the effects that the drugs might have on foetuses. A study that was published in the journal Molecular Psychiatry adds to the existing information on this topic. Researchers utilized two massive datasets to analyze more than 4.3 million pregnant women and determine whether stimulant medications caused birth defects. Researchers discovered that although the risk overall is low, first-trimester ADHD medication exposure was associated with slightly higher rates of certain heart defects, such as ventriculoseptal defect. The authors of the study could not discover any link between the use of early medications and other congenital anomalies like facial deformities, or club feet. The results are consistent with previous studies showing an increase, but not significant, in the risk of cardiac malformations among women who started taking ADHD medications prior to the time of the time of pregnancy. The risk grew in the latter half of pregnancy, when many women decide to stop taking their ADHD medication. Women who took ADHD medication in the first trimester of their pregnancies were also more likely to undergo caesarean sections, a low Apgar score after delivery and a baby who required breathing assistance at birth. However, visit the following website of the study were not able to eliminate selection bias by restricting the study to women who didn't have any other medical conditions that could have contributed to these findings. Researchers hope that their research will inform physicians when they meet pregnant women. The researchers recommend that while discussing risks and benefits are crucial, the decision regarding whether or not to stop medication should be made based on the severity of each woman's ADHD symptoms and her needs. The authors also caution that even though stopping the medication is an option, it is not an option that is recommended due to the high rate of depression and other mental health issues among women who are pregnant or postpartum. Further, research shows that women who stop taking their medication will have a harder adjustment to life without them once the baby is born. Nursing It can be a challenge to become a mom. Women with ADHD who have to deal with their symptoms while attending doctor appointments as well as preparing for the arrival of a baby and adjusting to new household routines are often faced with a number of difficulties. Therefore, many women decide to continue taking their ADHD medications throughout the course of pregnancy. The risk to a nursing infant is low because the majority of stimulant medication passes through breast milk in low amounts. However, the amount of medication exposure to the newborn may differ based on the dosage, frequency it is administered, and the time of the day the medication is administered. Additionally, individual medications enter the body of the baby differently through the gastrointestinal tract and breast milk, and the effect of this on a newborn infant is not yet fully known. Due to the absence of research, some physicians might be tempted to stop taking stimulant medication during the course of pregnancy. It's a difficult choice for the woman, who must weigh the benefits of continuing her medication against the risk to the foetus. Until more information becomes available, GPs can inquire about pregnant patients whether they have an background of ADHD or if they intend to take medication in the perinatal period. A growing number of studies have revealed that most women can safely continue their ADHD medication during pregnancy and while breastfeeding. In response, an increasing number of patients are choosing to do this. They have discovered, in consultation with their physicians that the benefits of keeping their current medication outweigh potential risks. It's important for women with ADHD who are thinking of breastfeeding to seek a specialist psychiatrist's advice prior becoming pregnant. They should review their medications with their physician and discuss the pros and cons of continued treatment, including non-pharmacological management strategies. Psychoeducation is also needed to help pregnant women suffering from ADHD be aware of the symptoms and underlying disorder. They should also learn about treatment options and strengthen coping mechanisms. This should include an approach that is multidisciplinary, including the GP doctors, obstetricians and psychiatrists. Pregnancy counseling should include a discussion of a treatment plan for the mother and child, and monitoring for signs of deterioration, and, if necessary, adjustments to the medication regime.