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ADHD Medication During Pregnancy and Breastfeeding The decision to stop or keep ADHD medication during pregnancy and breastfeeding is a challenge for women suffering from the condition. There are few data on how exposure to ADHD for a long time could affect a fetus. A recent study published in Molecular Psychiatry shows that children exposed to ADHD medication in the uterus do not develop neurological developmental conditions like impaired vision or hearing, febrile seizures, or IQ impairment. The authors acknowledge that more high quality studies are needed. Risk/Benefit Analysis Women who are expecting and taking ADHD medication should consider the benefits of taking it against the possible risks to the baby. Physicians don't have the data needed to make unequivocal recommendations, but they can provide information about benefits and risks that can help pregnant women make informed decisions. A study published in Molecular Psychiatry concluded that women who took ADHD medication in early pregnancy were not at greater risk of fetal malformations or structural birth defects. Researchers used a vast population-based case-control study to determine the prevalence of major structural birth defects in infants born to mothers who had taken stimulants during the early stages of pregnancy, as well as those who had not. Clinical geneticists and pediatric cardiologists reviewed the cases to ensure accurate case classification and to limit the chance of bias. The study conducted by the researchers had some limitations. Most important, they were not able to differentiate the effects of the medication from the disorder at hand. This limitation makes it difficult for researchers to determine if the small associations observed among the exposed groups were due to the use of medication, or if they were confounded by the presence of comorbidities. The researchers did not look at long-term outcomes for the offspring. The study did show that infants whose mothers took ADHD medication during pregnancy were at a higher risk of being admitted to the neonatal intensive care unit (NICU) than those whose mothers had not taken any medication or had taken off their medication prior to or during pregnancy. The reason for this was central nervous system disorders. The increased risk of admission was not affected by the stimulant medication 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 appeared to be unrelated to the type of medication used during pregnancy. Researchers suggest that the small risks posed by the use of ADHD medications in early pregnancies could be offset by the more beneficial outcomes for both mother and baby of continuing treatment for the woman's disorder. Physicians should speak with their patients about this issue and as much as possible, assist them improve coping skills which may reduce the effects of her disorder on her daily life and relationships. Medication Interactions More and more doctors are faced with the decision of whether to maintain treatment or stop it during pregnancy as more women are diagnosed with ADHD. These decisions are frequently taken without clear and authoritative evidence. Instead, physicians must take into account their own experience, the experience of other doctors, and the research on the topic. In particular, the issue of potential risks to the baby can be tricky. Many studies on this issue are based on observations rather than controlled research and their findings are often contradictory. Furthermore, most studies restrict their analysis to live births, which can underestimate severe teratogenic effects that cause abortion or termination of the pregnancy. The study that is discussed in this journal club addresses these shortcomings by examining data on both live and deceased births. The conclusion is that while certain studies have demonstrated an association between ADHD medications and the possibility of certain birth defects, others have not found any evidence of a link and the majority of studies show a neutral or even slight negative effect. Therefore, a careful risk/benefit analysis must be done in each instance. It can be challenging, if not impossible, for women suffering from ADHD to stop taking their medication. 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 being isolated. In addition, a decrease in medication may affect the ability to complete jobs and drive safely, which are important aspects of a normal life for a lot of people with ADHD. She suggests that women who are unsure whether to take the medication or stop due to pregnancy, educate their family members, colleagues, and their friends about the condition, the impact on daily functioning and the benefits of keeping the current treatment regimen. It can also help a woman feel supported in her decision. It is important to note that certain medications can be absorbed through the placenta so if a woman decides to discontinue her ADHD medication during pregnancy and breastfeeding, she must be aware of the possibility that traces of the drug can be transferred to the child. Birth Defects Risk As the use and use of ADHD medications to treat the symptoms of attention deficit disorder hyperactivity disorder (ADHD) increases the concern over the potential adverse effects of the drugs on foetuses. A recent study published in the journal Molecular Psychiatry adds to the existing information on this topic. Researchers used two massive data sets to examine over 4.3 million pregnant women and determine if stimulant medication use increased birth defects. While the overall risk remains low, the scientists did find that first-trimester exposure to ADHD medicines was associated with an increased risk of certain heart defects, like ventriculo-septal defects (VSD). The researchers of the study could not find any association between early use of medication and other congenital anomalies such as facial deformities or club feet. The results are in agreement with previous studies which showed a small, but significant increase in the number of cardiac malformations among women who started taking ADHD medication before the birth of their child. This risk increased during the latter half of pregnancy when many women began to stop taking their medication. best adhd medication for adults uk who took ADHD medication during the first trimester were more likely need a caesarean, have an insufficient Apgar after delivery and have a baby that needed breathing assistance after birth. The authors of the study could not eliminate selection bias because they restricted the study to women with no other medical conditions that might have contributed to the findings. Researchers hope that their research will inform physicians when they encounter pregnant women. They advise that while a discussion of the risks and benefits is crucial but the decision to stop or keep treatment should be based on the woman's requirements and the severity of her ADHD symptoms. The authors also caution that while discontinuing the medications is an option, it is not an option that is recommended due to the high prevalence of depression and other mental health problems among women who are pregnant or recently postpartum. Additionally, research suggests that women who stop taking their medications will have a harder transitioning to life without them once the baby is born. Nursing The responsibilities of a new mom can be overwhelming. Women who suffer from ADHD who have to deal with their symptoms while attending doctor appointments, getting ready for the arrival of a child and adapting to new routines in the home are often faced with a number of difficulties. As such, many women choose to continue taking their ADHD medication throughout the pregnancy. The majority of stimulant medications are absorbed through breast milk in low amounts, therefore the risk for breastfeeding infant is minimal. However, the frequency of exposure to medication by the newborn can vary depending on dosage, how often it is administered, and at what time it is administered. In addition, individual medications enter the baby's system differently through the gastrointestinal tract as well as breast milk and the impact of this on a newborn isn't yet fully understood. Some physicians may discontinue stimulant medications during a woman's pregnancy due to the lack of research. This is a complicated decision for the patient, who must weigh the benefits of keeping her medication against the potential risks to the foetus. As how to treat adhd without medication in adults as there is no more information, doctors should inquire with all pregnant patients about their experience with ADHD and whether they plan or are taking to take medication during the perinatal time. A increasing number of studies have proven that the majority of women are able to safely continue their ADHD medication during pregnancy and while breastfeeding. In the end, many patients choose to do so and, in consultation with their physician, they have found that the benefits of keeping their current medication far outweigh any 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 discuss their medication with their doctor and discuss the pros and cons for continuing treatment. This includes non-pharmacological strategies. Psychoeducation is also required to help pregnant women with ADHD recognize the signs and the underlying disorder. They should also be informed about treatment options and build the coping mechanisms. This should include an approach that is multidisciplinary, including the GP doctors, obstetricians and psychiatrists. The pregnancy counselling should consist of discussion of a management plan for both mother and child, and monitoring for signs of deterioration and when necessary, making adjustments to the medication regimen.