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ADHD Medication During Pregnancy and Breastfeeding The decision to stop or continue ADHD medications during pregnancy and breastfeeding is a challenge for women suffering from the condition. There is a lack of information about how long-term exposure to these drugs may affect the fetus. A recent study published in Molecular Psychiatry shows that children exposed to ADHD medication during the uterus don't develop neurological developmental disorders like hearing or vision impairment seizures, febrile seizures or IQ impairment. The authors acknowledge the need for more high-quality research. Risk/Benefit Analysis Women who are pregnant and taking ADHD medication need to consider the benefits of taking it versus the risks to the baby. Doctors don't have enough data to give clear advice, but can provide information on the risks and benefits to assist pregnant women to make informed choices. A study published in Molecular Psychiatry concluded that women who were taking ADHD medication during early pregnancy did not have a higher risk of fetal malformations, or structural birth defects. Researchers used a vast population-based case-control study to evaluate the incidence of major structural birth defects in infants born to mothers who had taken stimulants in the early stages of pregnancy and those who had not. Pediatric cardiologists and clinical geneticists looked over the cases to ensure an accurate classification of the cases and to reduce the chance of bias. The research conducted by the researchers was not without limitations. In particular, they were unable to separate the effects of the medication from the disorder at hand. This makes it difficult to know whether the small differences observed in the exposed groups result from medication use or comorbidities that cause confusion. Additionally the researchers did not study long-term offspring outcomes. 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) in comparison to mothers who did not take any medication during pregnancy or had discontinued taking their medication prior to or during pregnancy. This increase was due to central nervous system disorders, and the increased risk of admission did not appear to be affected by the type of stimulant medications were used during pregnancy. Women who took stimulant ADHD medication during pregnancy were also at an elevated chance of having a caesarean section or having a baby with an low Apgar score (less than 7). These increases appear to be unrelated to the type of medication taken during pregnancy. The research suggests that the low risk associated with the use of ADHD medications during the early stages of pregnancy may be offset by the higher benefit to both mother and child of continued treatment for the woman's condition. Physicians should discuss this with their patients and, where possible, assist them in developing strategies to improve coping skills that can lessen the effects of her disorder on her daily life and relationships. Medication Interactions As more women than ever before are being diagnosed with ADHD and treated with medication, the issue of whether to keep or discontinue treatment during pregnancy is a question that doctors are having to have to face. Most of the time, these decisions are made in the absence of clear and authoritative evidence either way, so physicians must weigh what they know, the experiences of other doctors, and what the research says on the topic, along with their best judgment for each patient. Particularly, the issue of potential risks for the infant can be difficult. Many studies on this topic are based on observational data rather than controlled research, and their conclusions are often contradictory. Most studies restrict their analysis to live-births, which could underestimate the severity of teratogenic effects that can lead to abortions or terminations of pregnancy. The study that is discussed in this journal club addresses these shortcomings by analyzing data on live and deceased births. Conclusion A few studies have found a positive correlation between ADHD medications and certain birth defects, other studies have not shown such a relationship. Most studies have shown an unintended, or slightly negative, impact. As a result an accurate risk-benefit analysis is required in every situation. For women suffering from ADHD, the decision to discontinue medication is 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 increase depression, feelings of loneliness and family conflict for those suffering from the disorder. Additionally, the loss of medication can affect the ability to complete jobs and drive safely which are essential aspects of a normal life for many people with ADHD. She suggests that women who are unsure whether to continue taking medication or stop it due to their pregnancy, educate their family members, colleagues, and acquaintances about the condition, its impact on daily functioning and the benefits of continuing the current treatment. It can also help women feel supported in her decision. Certain medications can pass through the placenta. If a woman decides to not take her ADHD medication while pregnant and breastfeeding, it is crucial to be aware that the medication may be transferred to her baby. Risk of Birth Defects As the use of ADHD medications to treat symptoms of attention deficit hyperactivity disorder (ADHD) increases as do concerns about the effects that the drugs could have on foetuses. Recent research published in the journal Molecular Psychiatry has added to the body of knowledge on this topic. Researchers used two massive data sets to study over 4.3 million pregnant women and determine if the use of stimulant medications increased the risk of birth defects. Researchers discovered that although the risk overall is low, the first trimester ADHD medication exposure was associated with slightly higher rates of specific heart defects like ventriculoseptal defects. The researchers of the study didn't find any association between early medication usage and other congenital anomalies like facial deformities, or club feet. The results are in the same vein as 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 before the time of pregnancy. This risk increased during the latter part of pregnancy, when many women are forced to stop taking their medication. Women who used ADHD medications during the first trimester of their pregnancies were also more likely to experience a caesarean section, a low Apgar score following delivery, and a baby that required breathing assistance at birth. However, the authors of the study were unable to eliminate bias due to selection by limiting the study to women who didn't have any other medical issues that could have contributed to these findings. adhd medication uk hope their research will aid in the clinical decisions of physicians who see pregnant women. They recommend that, while discussing risks and benefits is important but the decision to stop or maintain medication must be based on each woman's needs and the severity of her ADHD symptoms. The authors also advise that, while stopping the medication is an alternative, it is not a recommended practice because of the high prevalence of depression and other mental health issues in women who are pregnant or recently post-partum. Further, the research suggests that women who choose to stop taking their medications are more likely to experience difficulties adapting to life without them following the baby's arrival. Nursing It can be a stressful experience to become a mother. Women with ADHD who have to deal with their symptoms while attending physician appointments, making preparations for the arrival of a child and adapting to new routines in the home may face a lot of challenges. Therefore, many women choose to continue taking their ADHD medications throughout pregnancy. The risk to breastfeeding infant is not too high since the majority of stimulant medication passes through breast milk at low levels. However, the frequency of exposure to medication by the newborn can vary depending on dosage, how often it is administered, and at what time it is administered. In addition, various medications are introduced into the baby's system via the gastrointestinal tract, or through breast milk. The effect on a newborn's health is not fully comprehended. Because of the lack of research, some doctors might be tempted to stop taking stimulant medications during the pregnancy of a woman. It's a difficult choice for the woman who must weigh the benefits of continuing her medication against the risks to the fetus. In the meantime, until more information is available, GPs can ask pregnant patients whether they have any history of ADHD or if they are planning to take medication during the perinatal period. Numerous studies have demonstrated that women can continue to take their ADHD medication without risk during pregnancy and breast-feeding. In the end, more and more patients choose to do so and in consultation with their physician, they have discovered that the benefits of maintaining their current medication far outweigh any potential risks. Women who suffer from ADHD who plan to breastfeed should seek the advice of a specialist psychiatrist prior to becoming pregnant. They should discuss the medication they are taking with their physician and discuss the pros and cons of continuing treatment. This includes non-pharmacological methods. Psychoeducation is also required to help pregnant women suffering from ADHD recognize their symptoms and the underlying disorder, learn about available treatment options and reinforce existing strategies for coping. This should include an approach that is multidisciplinary, including the GP, obstetricians and psychiatry. The pregnancy counselling should consist of the discussion of a treatment plan for both mother and child, monitoring for signs of deterioration, and when necessary, making adjustments to the medication regimen.