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ADHD Medication During Pregnancy and Breastfeeding The decision to stop or continue ADHD medications during pregnancy and breastfeeding is a difficult decision for women suffering from the condition. There is a lack of information about how long-term exposure to these medications may affect the fetus. A recent study published in Molecular Psychiatry demonstrates that children exposed to ADHD medication during pregnancy do not develop neurological problems like hearing loss or vision, febrile seizures or IQ impairment. The authors acknowledge that further high-quality research is needed. Risk/Benefit Analysis Women who are pregnant and taking ADHD medication must evaluate the benefits of using it against the possible dangers for the foetus. Physicians don't have the information needed to give clear guidelines but they can provide information about the risks and benefits to aid pregnant women in making informed choices. medication for adhd published in Molecular Psychiatry found that women who were taking ADHD medications during early pregnancy did not have a significantly increased risk of fetal heart malformations or major structural birth defects. Researchers conducted a large, population-based case-control study to evaluate the incidence of major structural birth defects in infants born to mothers who had taken stimulants in early pregnancy, as well as those who had not. Pediatric cardiologists and clinical geneticists examined the cases to ensure accurate case classification and to minimize the possibility of bias. However, the study was not without its flaws. Researchers were unable, in the first place to differentiate the effects of the medication from the disorder. This limitation makes it difficult to determine whether the small differences observed in the groups that were exposed result from medication use or confounding by comorbidities. In addition the researchers did not examine the long-term effects of offspring on their parents. The study revealed that babies whose mothers took ADHD medication during pregnancy were at a slightly higher risk of admission to the neonatal care unit (NICU) as compared to those whose mothers did not use any medication during pregnancy or quit taking the medication prior to or during pregnancy. This increase was due to central nervous system-related disorders, and the increased risk of admission was not found to be influenced by the stimulant medication was used during pregnancy. Women who took stimulant ADHD medications during pregnancy also had a higher risk of having to have a caesarean section or a baby that scored low on the Apgar scale (less than 7). These increases appear to be unrelated to the type of medication taken during pregnancy. Researchers suggest that the small risk of using ADHD medications in early pregnancies may be offset by the more beneficial outcomes for both baby and mother of continued treatment for the woman’s disorder. Physicians should discuss the issue with their patients and, where they are able, assist them in developing strategies to improve coping skills which can reduce the impact of her disorder on her daily functioning and relationships. Medication Interactions Many doctors are confronted with the dilemma of whether to continue treatment or stop it during pregnancy as more women are diagnosed with ADHD. Most of the time, these decisions are taken in the absence of solid and reliable evidence either way, so physicians must weigh their knowledge from their own experiences, those of other doctors, and what the research suggests on the subject, along with their best judgment for each individual patient. Particularly, the issue of potential risks for the baby can be a challenge. Many studies on this issue are based on observational data rather than controlled research and their conclusions are often contradictory. Most studies focus on live births, which can underestimate the teratogenic impact leading to terminations or abortions of pregnancy. The study that is discussed in the journal club addresses these limitations by analyzing information on deceased and live births. The conclusion is that while some studies have shown an association between ADHD medications and the risk of certain birth defects, other studies have found no such relationship, and most studies have a neutral or slightly negative impact. In every case, a careful evaluation of the risks and benefits is required. For a lot of women with ADHD, the decision to discontinue medication is difficult if not impossible. In an article recently 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 patients with ADHD. The loss of medication can affect the ability to safely drive and perform work-related tasks, which are crucial aspects of daily life for those with ADHD. She suggests that women who are unsure whether to take the medication or discontinue it due to pregnancy educate family members, coworkers, and friends about the condition, the effects on daily functioning, and the benefits of continuing the current treatment regimen. In addition, educating them can make the woman feel more comfortable in her struggle with her decision. It is also worth noting that some drugs can pass through the placenta therefore, if a patient decides to discontinue her ADHD medication during pregnancy and breastfeeding, she should be aware of the possibility that traces of the medication could be passed on to the baby. Risk of Birth Defects 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 could have on foetuses. A recent study published in the journal Molecular Psychiatry adds to the body of knowledge on this subject. With two massive data sets researchers were able analyze more than 4.3 million pregnancies and see whether stimulant medication use increased the risk of birth defects. Researchers discovered that although the overall risk is low, first-trimester ADHD medication exposure 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 use of medication and other congenital anomalies such as facial deformities or club feet. The results are in the same vein as previous studies that showed an insignificant, but small increase in the number of cardiac malformations among women who began taking ADHD medication prior to the time of pregnancy. This risk increased during the latter part of pregnancy, as many women are forced to stop taking 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 needed help breathing at birth. However the researchers of the study were not able to eliminate selection bias by restricting the study to women who did not have any other medical issues that could have contributed to these findings. The researchers hope their research will help inform the clinical decisions of physicians who encounter pregnant women. They suggest that although a discussion of the risks and benefits is crucial however, the decision to stop or continue medication should be based on each woman's requirements and the severity of her ADHD symptoms. The authors caution that, while stopping the medication is an option to think about, it isn't advised because of the high incidence of depression and mental health issues in women who are expecting or have recently given birth. Additionally, research suggests that women who stop taking their medication will have a harder time adjusting to a life without them after the baby is born. Nursing The responsibilities of being a new mother can be overwhelming. Women suffering from ADHD may face a lot of challenges when they must manage their symptoms, go to doctor appointments and prepare for the birth of a child and adjust to new routines. Many women decide to continue taking their ADHD medication during pregnancy. The majority of stimulant medications pass through breast milk in low quantities, so the risk for nursing infant is very low. However, the frequency of medication exposure to the newborn can vary depending on the dosage, frequency it is taken and at what time it is administered. In addition, individual medications enter the infant's system differently through the gastrointestinal tract as well as breast milk. The impact of this on a newborn isn't fully understood. Due to the absence of research, some physicians may recommend stopping stimulant drugs during a woman's pregnancy. This is a difficult decision for the woman, who must weigh the benefits of her medication against the risks to the fetus. As long as more information is available, GPs may ask pregnant patients if they have any background of ADHD or if they are planning to take medication during the perinatal period. A growing number of studies have proven that the majority of women are able to safely continue their ADHD medication during pregnancy and breastfeeding. In the end, many patients choose to do so, and in consultation with their doctor they have discovered that the benefits of keeping their current medication far outweigh any risks. Women with ADHD who are planning to breastfeed should seek the advice of a specialist psychiatrist before becoming pregnant. They should discuss their medication with their doctor and discuss the pros and cons of continued treatment, including non-pharmacological strategies. Psychoeducation is also required to help women with ADHD recognize their symptoms and the underlying disorder and learn about treatment options and reinforce existing strategies for managing. This should be a multidisciplinary effort together with obstetricians, GPs, and psychiatry. Pregnancy counseling should consist of a discussion of a treatment plan for the mother as well as the child, as well as monitoring for signs of deterioration, and, if necessary adjustments to the medication regime.