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ADHD Medication During Pregnancy and Breastfeeding The choice of whether to stop or continue ADHD medications during pregnancy and nursing is challenging for women with the condition. There aren't many studies on how exposure to ADHD for a long time could affect a fetus. A study recently published in Molecular Psychiatry demonstrates that children exposed to ADHD medication during pregnancy do not develop neurological problems such as impaired hearing or vision, febrile seizures or IQ impairment. The authors acknowledge the need for more high-quality research. Risk/Benefit Analysis Pregnant women who use ADHD medications must weigh the advantages of using them against the risks to the foetus. Doctors don't have the necessary data to make unequivocal recommendations however they can provide information on risks and benefits that aid pregnant women in making informed choices. A study published in Molecular Psychiatry concluded that women who took ADHD medication during their early pregnancy did not have a greater risk of fetal malformations, or structural birth defects. link webpage used a large population-based study of case-control to evaluate the incidence of major structural birth defects in infants born to mothers who took stimulants during early pregnancy, and those who did not. Clinical geneticists, pediatric cardiologists and other experts examined the cases to confirm that the classification was correct and to reduce any bias. The research conducted by the researchers had some limitations. Most important, they were not able to differentiate the effects of the medication from the effects of the disorder at hand. This limitation makes it difficult to know whether the small associations observed in the groups that were exposed result from medication use or the confounding effect of comorbidities. Researchers also did not study long-term outcomes for the offspring. The study found that infants whose mothers took ADHD medication during pregnancy had a slightly higher chance 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. The reason for this was central nervous system disorders, and the higher risk of admission did not appear to be influenced by the stimulant medication was used during pregnancy. Women who were taking stimulant ADHD medications during pregnancy also had a higher risk of having to have an emergency caesarean section or having a baby that scored low on the Apgar scale (less than 7). These increases didn't seem to be influenced by the type of medication that was used during pregnancy. The researchers suggest that the low risk associated with the use of ADHD medications during early pregnancy could be offset by the greater benefits to both mother and child of continuing treatment for the woman's disorder. Doctors should discuss with their patients about this and, if possible, help them develop coping skills that can lessen the effects of her disorder on her daily life and relationships. Medication Interactions Many doctors are confronted with the dilemma of whether to keep treatment or stop during pregnancy as more women are diagnosed with ADHD. These decisions are usually made without clear and reliable evidence. Instead, doctors have to weigh their own knowledge, the experience of other physicians and the research that has been conducted on the subject. The issue of possible risks to infants is extremely difficult. Many of the studies on this topic are based on observational evidence rather than controlled research, and their conclusions are often contradictory. The majority of studies limit their analysis to live births, which may underestimate the severity of teratogenic effects 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 The conclusion: While certain studies have demonstrated a positive association between ADHD medications and the possibility of certain birth defects, other studies have not found any evidence of a link and the majority of studies have a neutral or slightly negative effect. As a result, a careful risk/benefit assessment must be conducted in every instance. For many women with ADHD and ADD, the decision to stop medication can be difficult, if not impossible. In a recent article in the Archives of Women's Mental Health, psychologist Jennifer Russell notes that stopping ADHD medication during pregnancy can lead to increased depression, feelings of loneliness and family conflict for these patients. The loss of medication can affect the ability to drive safely and perform work-related tasks, which are essential aspects of everyday life for people with ADHD. She suggests that women who are not sure whether to continue taking the medication or stop it due to their pregnancy should educate family members, coworkers and acquaintances about the condition, the impact on daily functioning and the benefits of keeping the current treatment plan. It can also help a woman feel confident about her decision. It is important to remember that some medications can be absorbed through the placenta so if the patient decides to discontinue her ADHD medication during pregnancy and breastfeeding, she must be aware that the effects of the drug could be transferred to the child. Birth Defects and Risk of As the use and misuse of ADHD medication to treat symptoms of attention deficit hyperactivity disorder (ADHD) increases the concern over the possible effects of the drugs on fetuses. Recent research published in the journal Molecular Psychiatry has added to the body knowledge on this topic. Using two massive data sets, researchers were able to analyze more than 4.3 million pregnancies and see whether stimulant medication use increased the risk of birth defects. While the overall risk remains low, the scientists did find that first-trimester exposure to ADHD medications was linked to an increased risk of specific heart defects, such as ventriculoseptal defect (VSD). The researchers behind the study found no association between early use of medication and other congenital abnormalities, like facial clefting, or club foot. The results are in the same vein as previous studies that have shown an insignificant, but small increase in cardiac malformations for women who started taking ADHD medication before pregnancy. The risk was higher during the latter part of pregnancy, when a lot of women begin to discontinue their ADHD medications. Women who used ADHD medications during the first trimester of their pregnancy were also more likely to have caesarean sections, a low Apgar score following delivery, and a baby who needed help breathing at birth. However the authors of the study were not able to eliminate selection bias by restricting the study to women who didn't have any other medical issues that could be a contributing factor to these findings. The researchers hope their research will serve to inform the clinical decisions of physicians who encounter pregnant women. They recommend that, while a discussion of the risks and benefits is crucial, the decision to stop or keep treatment must be based on each woman's requirements and the severity of her ADHD symptoms. The authors also warn that, while stopping the medication is an option, it is not an option to consider due to the high prevalence of depression and other mental health problems in women who are pregnant or recently postpartum. Research has also shown that women who stop taking their medications will have a difficult time adjusting to a life without them after the baby is born. Nursing The responsibilities of being a new mother can be overwhelming. Women with ADHD who have to manage their symptoms while attending physician appointments, making preparations for the arrival of a child and getting used to new routines at home are often faced with a number of difficulties. As such, many women decide to continue taking their ADHD medication throughout the pregnancy. The majority of stimulant medications pass through breast milk in low amounts, so the risk to breastfeeding infant is minimal. The rate of exposure to medication will differ based on dosage and frequency of administration as well as the time of day. In addition, different medications are introduced into the baby's system through the gastrointestinal tract or through breast milk. The impact on the health of a newborn is not fully known. Because of the lack of evidence, some doctors may be inclined to discontinue stimulant medication during the pregnancy of a woman. It's a difficult choice for the woman, who must weigh the benefits of her medication against the risk to the embryo. Until more information becomes available, doctors may ask pregnant patients whether they have an history of ADHD or if they intend to take medication during the perinatal stage. Numerous studies have proven that women can continue taking their ADHD medication in a safe manner during pregnancy and breast-feeding. In the end, more and more patients are choosing to do so and in consultation with their physician, they have discovered that the benefits of maintaining their current medication outweigh any risks. It is crucial for women suffering from ADHD who are thinking of breastfeeding to seek out a specialist psychiatrist's guidance prior to becoming pregnant. They should discuss the medication they are taking with their physician as well as the pros and cons of 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 root cause Learn about the available treatment options and reinforce existing strategies for managing. This should be a multidisciplinary approach with the GP as well as obstetricians, psychiatry and obstetricians. Counselling for pregnancy should include the discussion of a plan for management for both mother and child, and monitoring for signs of deterioration and, if necessary, adjustments to the medication regimen.