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ADHD Medication During Pregnancy and Breastfeeding The decision to stop or continue ADHD medications during breastfeeding and pregnancy is a difficult decision for women suffering from the condition. There are few data on how long-term exposure may affect the foetus. A recent study published in Molecular Psychiatry demonstrates that children exposed to ADHD medication during pregnancy do not develop neurological problems such as hearing loss or vision, febrile seizures or IQ impairment. The authors acknowledge the need for higher-quality research. Risk/Benefit Analysis Pregnant women who use ADHD medications must weigh the benefits of using them against the risks to the fetus. Doctors don't have enough data to make unambiguous recommendations however they can provide information about risks and benefits to assist pregnant women to make an informed decision. A study published in Molecular Psychiatry found that women who were taking ADHD medications during early pregnancy did not have an increased risk of fetal heart malformations or major structural birth defects. Researchers used a vast population-based study of case-control to determine the prevalence of major structural birth defects in babies born to mothers who took stimulants during the early stages of pregnancy, and those who did not. Clinical geneticists, pediatric cardiologists and other experts looked over the cases to make sure that the classification was accurate and to eliminate any bias. The study conducted by the researchers had some limitations. Most important, they were unable to distinguish the effects of the medication from those of the disorder that is underlying. This makes it difficult for researchers to determine if the few associations observed between the groups that were exposed to medication use or if they were caused by comorbidities. Additionally the study did not study the long-term outcomes of offspring. The study did show that infants whose mothers took ADHD medication during pregnancy were at slightly more risk of being admitted to the neonatal intensive care unit (NICU) than those who whose mothers did not take any medication or taken off their medication prior to or during pregnancy. This increase was due to central nervous system-related disorders and the higher risk of admission was not found to be influenced by the stimulant medications were taken during pregnancy. Women who were taking stimulant ADHD medication during pregnancy were also at an increased risk of having a caesarean section or having a child with low Apgar score (less than 7). These increases appear to be unrelated to the type of medication used during pregnancy. The research suggests that the risk of a small amount with the use of ADHD medications during early pregnancy may be offset by the higher benefit to both the mother and child of continued treatment for the woman's disorder. Doctors should discuss with their patients about this issue and try to help them develop coping strategies that could reduce the effects of her disorder on her daily functioning and her relationships. Medication Interactions As more women than ever are diagnosed with ADHD and being treated with medication, the question of whether to continue or end treatment during pregnancy is one that more and more doctors confront. medication for adhd are usually made without clear and reliable evidence. Instead, doctors have to consider their own expertise and experience, as well as the experiences of other doctors and the research on the topic. Particularly, the subject of possible risks to the baby can be a challenge. Many of the studies on this topic are based on observational data instead of controlled research and their findings are often contradictory. In addition, most studies limit their analysis to live births, which can underestimate severe teratogenic effects that cause abortion or termination of the pregnancy. The study presented in this journal club addresses these issues by examining data on both live and deceased births. Conclusion Some studies have found 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 somewhat negative, impact. In every case, a careful evaluation of the benefits and risks must be performed. It can be challenging, if not impossible, for women suffering from ADHD to stop taking their medication. In a recent piece published in the Archives of Women's Mental Health by psychologist Jennifer Russell, she notes that stopping ADHD medications during pregnancy can cause depression and feelings of being isolated. In addition, a decrease in medication can affect the ability to complete job-related tasks and drive safely which are essential aspects of a normal life for a lot of people with ADHD. She recommends that women who are unsure about whether to keep or discontinue medication due to their pregnancy, consider the possibility of educating friends, family members, and coworkers on the condition, its impact on daily functioning, and on the advantages of staying on the current treatment plan. It can also help a woman feel supported in her decision. Certain medications can pass through the placenta. If a patient decides to stop taking her ADHD medication while pregnant and breastfeeding, it's important to be aware that the drug could be passed on to her infant. Risk of Birth Defects As the use and use of ADHD medication to treat symptoms of attention deficit disorder hyperactivity disorder (ADHD), increases the concern over the potential adverse effects of the drugs on fetuses. A study that was published in the journal Molecular Psychiatry adds to the existing knowledge on this subject. Utilizing two huge data sets researchers were able to examine more than 4.3 million pregnancies and determine whether the use of stimulant medications increased the risk of birth defects. Researchers found that while the risk overall is low, the first trimester ADHD exposure to medication was associated with slightly higher risk of specific heart defects such as ventriculoseptal defect. The researchers of the study did not discover any link between early medication usage and other congenital anomalies, like facial deformities or club feet. The results are in line with previous studies revealing the presence of a small, but significant increase in the risk of cardiac malformations among women who started taking ADHD medications before pregnancy. This risk increased in the latter half of pregnancy, as many women begin to discontinue their ADHD medication. Women who used ADHD medications during the first trimester of their pregnancies were also more likely to experience caesarean section, low Apgar score following delivery, and a baby who required breathing assistance at birth. The authors of the study were unable to eliminate bias due to selection because they limited the study to women with no other medical conditions that might have contributed to the findings. The researchers hope their study will serve to inform the clinical decisions of physicians who encounter pregnant women. The researchers suggest that while discussing the risks and benefits are crucial, the decision about whether to continue or stop medication should be in light of the severity of each woman's ADHD symptoms and the needs of the woman. The authors caution that, even though stopping the medication is a possibility to consider, it is not recommended because of the high incidence of depression and mental health issues in women who are expecting or who have recently given birth. Furthermore, research suggests that women who decide to stop their medications are more likely to experience difficulties adjusting to life without them following the birth of their baby. Nursing The responsibilities of a new mother can be overwhelming. Women suffering from ADHD are often faced with a number of difficulties when they must deal with their symptoms, go to doctor appointments and prepare for the birth of their child and adjust to a new routine. As such, many women decide to continue taking their ADHD medications throughout the course of pregnancy. The risk to nursing infant is low because the majority of stimulant medication passes through breast milk at a low level. However, the rate of exposure to medication by the infant can differ based on the dosage, frequency it is administered, and at what time the medication is administered. In addition, different drugs enter the infant's system through the gastrointestinal tract or breast milk. The impact on the health of a newborn isn't fully known. Some doctors may stop taking stimulant medication during a woman's pregnancy due to the lack of research. It's a difficult choice for the woman who must weigh the advantages of continuing her medication against the risks to the foetus. In the meantime, until more information is available, doctors can ask pregnant patients whether they have an history of ADHD or if they are planning to take medication in the perinatal period. Numerous studies have demonstrated that women can continue taking their ADHD medication in a safe manner during pregnancy and breast-feeding. As a result, an increasing number of patients are choosing to do so, and in consultation with their doctor they have found that the benefits of continuing their current medication far outweigh any potential risks. Women with 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 as well as the pros and cons for continuing treatment. This includes non-pharmacological strategies. 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 coping. This should be a multidisciplinary approach with the GP as well as obstetricians, psychiatry and obstetricians. Counselling for pregnancy should include discussion of a management plan for both mother and child, and monitoring for signs of deterioration, and, if necessary, adjustments to the medication regimen.