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ADHD Medication During Pregnancy and Breastfeeding Women suffering from ADHD have to make a difficult choice about whether to continue or stop taking ADHD medication during pregnancy and breast-feeding. There aren't enough data on how long-term exposure may affect the fetus. A recent study published in Molecular Psychiatry demonstrates that children exposed to ADHD medication during pregnancy do not develop neurological issues such as hearing loss or vision, 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 medication need to weigh the benefits of taking it versus the risks for the foetus. Physicians do not have the information needed to provide clear recommendations but they can provide information on benefits and risks that can aid pregnant women in making informed choices. A study published in Molecular Psychiatry concluded that women who took ADHD medication during their early pregnancy were not at higher risk of fetal malformations, or structural birth defects. Researchers conducted a large population-based case-control study to evaluate the incidence of major structural birth defects in infants born to mothers who had taken stimulants during the early stages of pregnancy and those who had not. Clinical geneticists and pediatric cardiologists looked over the cases to ensure accurate case classification and to minimize the possibility of bias. However, the researchers' study was not without its flaws. The researchers were not able, in the first place, to separate the effects of the medication from the disorder. This limitation makes it difficult for researchers to determine whether the small associations observed among the groups that were exposed to the use of medication or affected by co-morbidities. In addition, the researchers did not study the long-term outcomes of offspring. The study found that infants whose mother took ADHD medication during pregnancy had a slightly higher risk of admission to the neonatal care unit (NICU) as compared to those whose mothers did not take any medication during pregnancy, or had stopped taking their medication before or during pregnancy. This increase was due to central nervous system-related disorders and the increased risk for admission was not found to be influenced by the stimulant medications were 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 appeared to be unrelated to the type of medication taken during pregnancy. The research suggests that the risk of a small amount with the use of ADHD medications during the early stages of pregnancy may be offset by the greater benefits to both mother and child of continuing treatment for the woman's condition. Physicians should speak with their patients about this issue and try to help them improve coping skills which could reduce the effects of her disorder on her daily functioning and her relationships. Interactions with Medication More and more doctors are confronted with the dilemma of whether to keep 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 take into account their own experience in conjunction with the experiences 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 observations instead of controlled studies and many of the findings are in conflict. Furthermore, most studies restrict their analysis to live births, which could underestimate severe teratogenic effects that lead to abortion or termination of the pregnancy. The study that is discussed in this journal club addresses these limitations by examining data on both live and deceased births. The conclusion The conclusion: While certain studies have demonstrated that there is a positive correlation between ADHD medications and the risk of certain birth defects, other studies have found no such relationship and the majority of studies show a neutral or even slightly negative impact. In the end, a careful risk/benefit assessment must be conducted in every instance. For a lot of women with ADHD, the decision to discontinue medication is difficult, if not impossible. In a recent piece published in Archives of Women's Mental Health by psychologist Jennifer Russell, she notes that stopping ADHD medications during pregnancy can increase depression and feelings of being isolated. Furthermore, a loss of medication can interfere with the ability to do jobs and drive safely that are crucial aspects of daily life for a lot of people with ADHD. She suggests that women who are not sure whether to take the medication or stop due to pregnancy should educate family members, coworkers and acquaintances about the condition, the effects on daily functioning, and the advantages of staying on the current treatment plan. Educating them can also help the woman feel supported when she is struggling with her decision. Certain medications can pass through the placenta. If the patient decides to stop taking her ADHD medication while breastfeeding, it is crucial to be aware that the drug could be transferred to the baby. Risk of Birth Defects As the use and abuse of ADHD medication to treat symptoms of attention deficit hyperactivity disorder (ADHD) is increasing the concern over the potential effects of these drugs on the fetuses. Recent research published in the journal Molecular Psychiatry has added to the body knowledge on this subject. Utilizing two huge data sets researchers were able to analyze more than 4.3 million pregnancies to determine whether the use of stimulant medications increased the risk of birth defects. Although the risk overall is low, the researchers did find that first-trimester exposure to ADHD medications was linked to a slightly higher rate of certain heart defects, such as ventriculo-septal defect (VSD). The authors of the study didn't discover any connection between the use of early medications and other congenital anomalies, such as facial deformities or club feet. The results are in line with previous studies that showed a small, but significant increase in cardiac malformations for women who began taking ADHD medication before the birth of their child. This risk increased in the later part of pregnancy, as many women decide to stop taking their ADHD medications. Women who used ADHD medication in the first trimester of pregnancy were also more likely to undergo caesarean section, low Apgar score following delivery, and a baby that required breathing assistance during birth. However the researchers of the study were not able to eliminate bias due to selection by restricting the study to women who did not have any other medical conditions that could be a contributing factor to these findings. Researchers hope that their study will inform physicians when they see pregnant women. They recommend that, while a discussion of the benefits and risks is important but the decision to stop or keep treatment should be based on the woman's requirements and the severity of her ADHD symptoms. The authors warn that, while stopping the medication is an option to consider, it is not recommended due to the high prevalence of depression and other mental disorders among women who are pregnant or recently gave birth. Further, the research suggests that women who choose to stop their medications are more likely to have difficulties adapting to life without them following the baby's arrival. Nursing It can be a challenge to become a mom. Women who suffer from ADHD who must work through their symptoms while attending physician appointments, getting ready for the arrival of a baby and getting used to new routines at home can experience severe challenges. Therefore, many women elect to continue taking their ADHD medications throughout the course of pregnancy. The risk to breastfeeding infant is not too high since the majority of stimulant medications passes through breast milk at a low level. The rate of exposure to medication will differ based on dosage and frequency of administration as well as the time of day. Additionally, different drugs enter the infant's system via the gastrointestinal tract or through breast milk. The impact of these medications on the health of a newborn is not completely understood. Due to the absence of research, some doctors may be inclined to discontinue stimulant medication during the pregnancy of a woman. This is a difficult decision for the patient, who must balance the benefit of continuing her medication with the potential risks to the foetus. In the meantime, until more information is available, GPs may ask pregnant patients whether they have an background of ADHD or if they plan to take medication in the perinatal phase. A increasing number of studies have shown that most women can safely continue to take their ADHD medication while they are pregnant and nursing. In the end, more and more patients choose to do so and, in consultation with their doctor they have found that the benefits of maintaining their current medication outweigh any potential 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 doctor as well as the pros and cons for continuing treatment. medications for adhd in adults Iam Psychiatry includes non-pharmacological methods. Psychoeducation should also be offered to help pregnant people with ADHD be aware of their symptoms and the underlying disorder Learn about the available treatments and to reinforce existing strategies for managing. This should be a multidisciplinary approach including obstetricians, GPs, and psychiatrists. The pregnancy counselling should consist of the discussion of a plan for management for both mother and child, as well as monitoring for signs of deterioration and, if necessary, adjustments to the medication regimen.