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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. There isn't much information on how long-term exposure to these medications could affect the fetus. A recent study published in Molecular Psychiatry shows that children exposed to ADHD medication during utero do not develop neurological conditions like hearing loss or impaired vision 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 must weigh the benefits of using them against the risks to the foetus. Doctors don't have the data needed to make unequivocal recommendations, but they can provide information on the risks and benefits to aid pregnant women in making informed decisions. A study published in Molecular Psychiatry concluded that women who were taking ADHD medication during early pregnancy were not at a higher risk of fetal malformations or structural birth defects. Researchers conducted a massive population-based study of case control to assess the frequency of major structural defects in infants who were born to mothers who were taking stimulants during pregnancy. Clinical geneticists and pediatric cardiologists reviewed the cases to ensure an accurate case classification and to limit the chance of bias. The study conducted by the researchers was not without its limitations. The most important issue was that they were unable to distinguish the effects of the medication from the disorder at hand. This limitation makes it difficult for researchers to determine whether the few associations observed between the groups exposed were due to the use of medication or if they were confounded by co-morbidities. Researchers also did not look at long-term outcomes for offspring. The study showed that infants whose mothers had taken ADHD medication during pregnancy had a slightly greater risk of being admitted to the neonatal care unit (NICU) as compared to those whose mothers didn't take any medication during pregnancy, or had discontinued taking their medication prior to or during pregnancy. This increase was caused by central nervous system disorders. The increased risk of admission was not influenced by the stimulant medication used during pregnancy. Women who were taking stimulant ADHD medication during pregnancy also had an elevated chance of having a caesarean section or having a child with low Apgar score (less than 7). These risks did not appear to be influenced by the type of medication that was used during pregnancy. The research suggests that the risk of a small amount with the use of ADHD medications during the early stages of pregnancy could be offset by the greater benefit for both mother and child from continued treatment for the woman's disorder. Physicians should talk to their patients about this and, if possible, help them improve coping skills which may reduce the effects of her disorder on her daily functioning and her relationships. Medication Interactions As more women than ever before are being 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. These decisions are frequently made without clear and reliable evidence. Instead, doctors must take into account their own experience in conjunction with the experiences of other physicians and the research that has been conducted on the subject. Particularly, the subject of potential risks for the baby can be tricky. The research that has been conducted on this topic is based on observations instead of controlled studies and the results are contradictory. The majority of studies focus on live births, which may underestimate the severity of teratogenic effects leading to abortions or terminations of pregnancy. The study presented in the journal club addresses these shortcomings by analyzing data on live and deceased births. Conclusion: While some studies have shown an association between ADHD medications and certain birth defects However, other studies haven't found a correlation. Most studies have shown a neutral, or even slight negative impact. As a result, a careful risk/benefit analysis is required in every instance. It can be challenging, if not impossible for women with ADHD to stop taking their medication. In an article 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 patients with ADHD. Furthermore, a loss of medication can affect the ability to do jobs and drive safely, which are important aspects of a normal life for many people with ADHD. She suggests that women who are unsure whether to take the medication or discontinue it due to pregnancy educate family members, coworkers, and friends about the condition, its impact on daily functioning and the advantages of staying on the current treatment. In addition, educating them can aid in ensuring that the woman feels supported in her struggle with her decision. Some medications can pass through the placenta. If a woman decides to stop taking her ADHD medication while breastfeeding, it is crucial to be aware that the medication may be transferred to her infant. Risk of Birth Defects As the use of ADHD medications to treat symptoms of attention deficit hyperactivity disorder (ADHD) grows as do concerns about what impact the drugs could have on fetuses. Recent research published in the journal Molecular Psychiatry has added to the body of knowledge on this issue. Researchers used two massive data sets to examine over 4.3 million pregnancy and determine if stimulant medication use increased the risk of birth defects. Researchers found that while the risk overall is low, the first trimester ADHD medication exposure was associated with slightly higher rates of certain heart defects, like ventriculoseptal defects. The authors of the study did not find any association between early medication usage and other congenital anomalies, like facial deformities, or club feet. The results are consistent with previous studies that have shown the presence of a small, but significant increase in the risk of developing cardiac malformations in women who started taking ADHD medications before the time of pregnancy. This risk increased during the latter half of pregnancy, when a lot of women stopped taking their medication. Women who took ADHD medication during the first trimester were more likely require a caesarean delivery and also have a low Apgar after delivery, and have a baby that needed help breathing after birth. However, the authors of the study were not able to eliminate selection bias by limiting the study to women who did not have any other medical conditions that could have contributed to the findings. Researchers hope their research will inform physicians when they see pregnant women. They recommend that, while discussing risks and benefits is important but the decision to stop or continue medication should be based on the woman's needs and the severity of her ADHD symptoms. The authors warn that, although stopping the medication is an option to look into, it is not recommended 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 medications will have a tough adjustment to life without them once the baby is born. Nursing It can be overwhelming to become a mom. Women with ADHD who have to manage their symptoms while attending physician appointments, preparing for the arrival of a baby and getting used to new routines at home can experience severe challenges. As such, many women choose to continue taking their ADHD medication throughout the pregnancy. iampsychiatry.uk to a nursing infant is low because the majority of stimulant medications passes through breast milk at a low level. However, the frequency of exposure to medication by the infant can differ based on the dosage, frequency it is administered and the time of the day it is administered. Additionally, individual medications enter the body of the baby differently through the gastrointestinal tract and breast milk and the impact of this on a newborn isn't well known. Some doctors may stop taking stimulant medication during a woman’s pregnancy due to the lack of research. This is a difficult choice for the patient, who must weigh the benefit of continuing her medication against the potential risks to the foetus. Until more information becomes available, doctors may inquire about pregnant patients whether they have an background of ADHD or if they plan to take medication during the perinatal phase. A growing number of studies have shown that the majority of women are able to safely continue their ADHD medication during pregnancy and breastfeeding. In response, a rising number of patients are opting to continue their medication. They have discovered through consultation with their doctors that the benefits of continuing their current medication outweigh any possible risks. It is crucial for women suffering from ADHD who are contemplating breastfeeding to seek out a specialist psychiatrist's advice prior becoming pregnant. They should review their medications with their doctor and discuss the pros and cons of continued treatment, including non-pharmacological strategies. Psychoeducation is also necessary to help pregnant women with ADHD recognize the signs and the underlying disorder. They should also learn about treatment options and build coping mechanisms. This should involve an approach that is multidisciplinary, including the GP, obstetricians and psychiatry. Pregnancy counseling should consist of a discussion of a treatment plan for the mother and the child, monitoring of signs of deterioration and, if needed adjustments to the medication regimen.