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ADHD Medication During Pregnancy and Breastfeeding The choice of whether to stop or continue ADHD medications during pregnancy and breastfeeding is a challenge for women suffering from the condition. There aren't many studies on how long-term exposure may affect a foetus. A recent study published in Molecular Psychiatry shows that children exposed to ADHD medication during the uterus don't develop neurological developmental disorders such as hearing loss or impaired vision seizures, febrile seizures, or IQ impairment. The authors acknowledge that further high-quality studies are required. Risk/Benefit Analysis Pregnant women who use ADHD medications need to balance the advantages of using them against the risks to the fetus. Physicians don't have the necessary data to give clear guidelines, but they can provide information on the risks and benefits to assist pregnant women in making informed choices. A study published in Molecular Psychiatry found that women who used ADHD medications during their early pregnancy did not have an higher risk of fetal cardiac malformations or major birth defects that are structural. Researchers conducted a massive population-based case control study to examine the prevalence of major structural defects in infants who were born to mothers who took stimulants during pregnancy. Pediatric cardiologists and clinical geneticists examined the cases to ensure an accurate case classification and to limit the chance of bias. However, the researchers' study was not without its flaws. The most important issue was that they were unable to separate the effects of the medication from the effects of the disorder that is underlying. That limitation makes it difficult to know whether the limited associations observed in the exposed groups are due to medication use or comorbidities that cause confusion. In addition, the researchers did not examine the long-term outcomes of offspring. The study found that infants whose mother had taken ADHD medication during pregnancy were at a slightly higher risk of admission to the neonatal care unit (NICU), compared to mothers who didn't take any medication during pregnancy or had stopped taking their medication before or during pregnancy. The reason for this was central nervous system-related disorders and the higher risk of admission did not appear to be influenced by the stimulant medications were taken during pregnancy. Women who took stimulant ADHD medications during pregnancy also had a higher risk of having to have caesarean sections or a baby that scored low on the Apgar scale (less than 7). These increases appeared to be unrelated to the type of medication used during pregnancy. The researchers suggest that the small risk associated with the use of ADHD medications during early pregnancy could be offset by the higher benefit to both mother and child of continued treatment for the woman's disorder. Physicians should discuss the issue with their patients and, when possible, assist them in developing strategies to improve their coping abilities that may minimize the negative impact of her condition on her daily life and relationships. Medication Interactions As more women than ever are being diagnosed with ADHD and being treated with medication, the dilemma of whether to keep or stop treatment during pregnancy is a question that more and more physicians face. The majority of these decisions are made without clear and authoritative evidence regardless, so doctors have to weigh their experience from their own experiences, those of other doctors, and what research suggests about the subject and their best judgment for each patient. Particularly, the issue of potential risks for the baby can be tricky. Many of the studies on this issue are based on observations instead of controlled research and their findings are often contradictory. Most studies focus on live births, which may underestimate the teratogenic impact 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. The conclusion is that while some studies have shown a positive association between ADHD medications and the risk of certain birth defects, other studies have found no connection, and most studies demonstrate a neutral or slightly negative impact. In each case an in-depth evaluation of the risks and benefits should be conducted. For women suffering from ADHD who suffer from ADHD, the decision to stop taking medication can be difficult, if not impossible. In a recent article 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 loneliness. Additionally, the loss of medication may affect the ability to complete job-related tasks and drive safely which are essential aspects of a normal life for many people suffering from ADHD. She suggests women who are uncertain about whether or not to discontinue medication due to their pregnancy, consider the possibility of educating friends, family members and colleagues about the condition, its impact on daily functioning, and on the benefits of keeping the current treatment regimen. In addition, educating them can help the woman feel supported in her struggle with her decision. Certain medications can be passed through the placenta. If a woman decides to stop taking her ADHD medication while breastfeeding, it is crucial to be aware that the drug 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) grows as do concerns about the effects that the drugs could have on foetuses. A study that was published in the journal Molecular Psychiatry adds to the existing information on this topic. Utilizing two huge data sets researchers were able to examine more than 4.3 million pregnancies to determine whether stimulant medications increased the risk of birth defects. Although the risk overall remains low, the researchers discovered that the first-trimester exposure to ADHD medications was linked to a slightly higher rate of certain heart defects, such as ventriculoseptal defect (VSD). The authors of the study found no association between early use of medication and other congenital anomalies, like facial clefting, or club foot. 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 among women who started taking ADHD medications prior to the time of pregnancy. The risk increased in the latter stages of pregnancy when many women decided to stop taking their medication. medication for adhd in adults who were taking ADHD medication during the first trimester were more likely to need a caesarean and also have an insufficient Apgar after delivery and have a baby that needed breathing assistance when they were born. However, the authors of the study were not able to eliminate bias due to selection by restricting the study to women who didn't have any other medical conditions that could be a contributing factor to these findings. The researchers hope that their research will aid in 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 continue treatment should be based on the woman's requirements and the severity of her ADHD symptoms. The authors also caution that even though stopping the medication is an option, it is not an option to consider due to the high incidence of depression and other mental health problems for women who are expecting or who are recently postpartum. Furthermore, research suggests that women who choose to stop their medications are more likely to have a difficult time adapting to life without them following the baby's arrival. Nursing It can be a challenge to become a mom. Women with ADHD who must work through their symptoms while attending physician appointments as well as getting ready for the arrival of a child and adapting to new routines in the home are often faced with a number of difficulties. Many women choose to continue taking their ADHD medication during pregnancy. The risk for breastfeeding infant is not too high since the majority of stimulant medications is absorbed through breast milk at a low level. The amount of exposure to medications can vary depending upon the dosage the medication is administered, its frequency and the time of the day. In addition, various medications enter the baby’s system via the gastrointestinal tract or through breast milk. The impact on the health of a newborn isn't fully understood. Due to the absence of research, some physicians may recommend stopping stimulant medications during the course of pregnancy. It's a difficult choice for the woman who must weigh the benefits of her medication against the risk to the foetus. Until more information becomes available, GPs can ask pregnant patients whether they have an background of ADHD or if they are planning to take medication in the perinatal stage. A increasing number of studies have proven that women can continue their ADHD medication during pregnancy and breastfeeding. In response, a rising number of patients are opting to continue their medication. They have concluded, in consultation with their doctors, that the benefits of keeping their current medication far outweigh any risk. It is crucial for women suffering from ADHD who are thinking of breastfeeding to seek a specialist psychiatrist's advice prior to becoming pregnant. They should discuss their medication with their physician and discuss the pros and cons of continued treatment, including non-pharmacological strategies. Psychoeducation should also be provided to help pregnant people with ADHD be aware of their symptoms and underlying disorder, learn about available treatment options and reinforce existing coping strategies. This should be a multidisciplinary approach including obstetricians, GPs, and psychiatrists. Counselling for pregnancy should include the discussion of a plan for management for both the mother and child, as well as monitoring for signs of deterioration, and, if necessary, adjustments to the medication regimen.