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ADHD Medication During Pregnancy and Breastfeeding The choice of whether to stop or continue ADHD medications during breastfeeding and pregnancy is challenging for women with the condition. There isn't much information on how long-term exposure to these drugs may affect the fetus. A recent study published in Molecular Psychiatry demonstrates that children exposed to ADHD medication during pregnancy do not develop neurological issues like hearing loss or vision, febrile seizures, or IQ impairment. The authors acknowledge the need for more high-quality studies. Risk/Benefit Analysis Women who are expecting and taking ADHD medication need to consider the benefits of taking it versus the dangers for the baby. Doctors don't have the necessary data to provide clear recommendations however they can provide information regarding risks and benefits that assist pregnant women in making informed decisions. A study published in Molecular Psychiatry found that women who were taking ADHD medications during their early pregnancy did not have an increased risk of fetal cardiac malformations or major structural birth defects. The researchers used a large population-based case-control study to determine the prevalence of major structural birth defects in babies born to mothers who had taken stimulants during the early stages of pregnancy and those who had not. Clinical geneticists, pediatric cardiologists and other experts looked over the cases to make sure that the classification was correct and to eliminate any bias. The research conducted by the researchers was not without limitations. The researchers were unable in the beginning to distinguish the effects triggered by the medication from the disorder. This makes it difficult for researchers to determine whether the small associations observed among the groups exposed were due to the use of medications or affected by the presence of comorbidities. Researchers also did not study long-term outcomes for offspring. The study did find that infants whose mothers took ADHD medications during pregnancy were at a slightly greater risk of being admitted to the neonatal intensive care unit (NICU) than those who were born without any medication or had stopped their medications before or during pregnancy. This was due to central nervous system disorders. The higher risk of admission was not affected by the stimulant medication used during pregnancy. Women who took stimulant ADHD medications during pregnancy also had a higher chance of having to have an emergency caesarean section or having a baby that scored low on the Apgar scale (less than 7). These increases appear to be independent of the type of medication taken during pregnancy. The researchers suggest that the low risk associated with the use of ADHD medications during the early stages of pregnancy may be offset by the greater benefit for both mother and child from continued treatment for the woman's disorder. Physicians should discuss the issue with their patients and, where possible, help them develop strategies to improve coping skills that may minimize the impact of her disorder on her daily functioning and relationships. Medication Interactions More and more doctors are faced with the decision of whether to maintain treatment or stop as more women are diagnosed with ADHD. These decisions are usually taken without clear and authoritative evidence. Instead, doctors must weigh their own knowledge in conjunction with the experiences of other doctors and the research on the topic. In particular, the issue of potential risks for the baby can be a challenge. The research on this issue is based on observation rather than controlled studies and many of the findings are contradictory. Most studies limit their analysis to live births, which may underestimate the severity of teratogenic effects that can lead to abortions or terminations of pregnancy. The study discussed in the journal club addresses these limitations by analyzing both the data from deceased and live births. Conclusion Some studies have shown a positive correlation between ADHD medications and certain birth defects, other studies have not found a correlation. The majority of studies show that there is a neutral, or somewhat negative, impact. As a result, a careful risk/benefit analysis is required in every case. It can be challenging, if not impossible for women suffering from ADHD to stop taking their medication. In fact, in an article published 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 isolation, and family conflict for these patients. A loss of medication may also affect the ability to drive safely and complete work-related tasks, which are vital aspects of daily life for those suffering from ADHD. She recommends that women who are unsure about whether to keep or stop medication in light of their pregnancy consider educating family members, friends and colleagues about the condition, its impact on daily life, and the advantages of staying on the current treatment plan. It can also help the woman feel supported in her struggle with her decision. It is important to note that certain medications can pass through the placenta so if the patient decides to stop taking her ADHD medication during pregnancy and breastfeeding, she should be aware that the effects of the drug can be passed on to the baby. Birth Defects and Risk of As the use of ADHD drugs to treat symptoms of attention deficit hyperactivity disorder (ADHD) increases there are concerns about the effects that the drugs might have on fetuses. Recent research published in the journal Molecular Psychiatry has added to the body knowledge on this topic. Utilizing two huge data sets, researchers were able to analyze more than 4.3 million pregnancies and determine whether the use of stimulant medications increased the risk of birth defects. While the overall risk is low, the researchers did find that first-trimester exposure to ADHD medications was associated with an increase in the risk of specific heart defects, like ventriculo-septal defects (VSD). The researchers of the study didn't discover any link between early use of medication and other congenital anomalies like facial deformities, or club feet. The findings are in line with previous studies showing a small but significant increase in the risk of cardiac malformations among women who began taking ADHD medications prior to the time of pregnancy. adhd medication for adults increased in the latter stages of pregnancy when a large number of women stopped taking their medication. Women who used ADHD medications in the first trimester of their pregnancy were also more likely to undergo caesarean section, low Apgar score after delivery and a baby who needed help breathing at birth. However the authors of the study were not able to eliminate bias due to selection by limiting the study to women who didn't have other medical issues that could be a contributing factor to these findings. The researchers hope their study will help inform the clinical decisions of physicians who treat pregnant women. The researchers advise that, while discussing risks and benefits are important, the choice regarding whether or not to stop medication should be made based on the severity of each woman's ADHD symptoms and her requirements. The authors also caution that even though stopping the medication is an option, it isn't an option that is recommended due to the high rate of depression and other mental health issues among women who are pregnant or recently post-partum. Additionally, research suggests that women who stop taking their medications will have a tough transitioning to life without them after the baby is born. Nursing It can be a stressful experience to become a mother. Women with ADHD who have to manage their symptoms while attending physician appointments as well as getting ready for the arrival of a baby and adapting to new routines in the home can experience severe challenges. Therefore, many women choose to continue taking their ADHD medication throughout the pregnancy. The majority of stimulant drugs are absorbed through breast milk in low amounts, so the risk for nursing infant is very low. However, the rate of medication exposure to the newborn may differ based on dosage, frequency it is administered and at what time the medication is administered. In addition, different medications are introduced into the baby's system through the gastrointestinal tract or breast milk. The effect on the health of a newborn is not fully comprehended. Some physicians may discontinue stimulant medication during a woman's pregnancy due to the lack of research. It is a difficult decision for the woman, who must weigh the benefits of continuing her medication against the potential risks to the embryo. Until more information is available, doctors should ask all pregnant patients about their experience with ADHD and if they plan or are taking to take medication during the perinatal time. A increasing number of studies have proven that most women can safely continue their ADHD medication while they are pregnant and nursing. In response, a growing number of patients are choosing to do so. They have found, in consultation with their doctors that the benefits of keeping their current medication outweigh any potential risks. Women with ADHD who plan to breastfeed should seek the advice of a specialist psychiatrist before becoming pregnant. They should review their medications with their doctor and discuss the pros and cons of continued treatment, including non-pharmacological management strategies. Psychoeducation is also required to help pregnant women suffering from ADHD be aware of the symptoms and underlying disorder. They should also be educated about treatment options and strengthen strategies for coping. This should be a multidisciplinary approach together with obstetricians, GPs, and psychiatrists. The pregnancy counselling should consist of discussion of a management plan for both the mother and child, and monitoring for signs of deterioration and, if necessary, adjustments to the medication regimen.