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ADHD Medication During Pregnancy and Breastfeeding The choice of whether to stop or continue ADHD medication during pregnancy and breastfeeding is a challenge for women suffering from the condition. There aren't enough data on how long-term exposure may affect a fetus. A recent study published in Molecular Psychiatry shows that children exposed to ADHD medication in the uterus do not develop neurological disorders such as hearing loss or impaired vision, febrile seizures, or IQ impairment. The authors acknowledge the need for more high-quality studies. Risk/Benefit Analysis Pregnant women who use ADHD medications need to balance the advantages of taking them against the potential risks to the foetus. Physicians don't have the necessary data to give clear guidelines however they can provide information on risks and benefits that help pregnant women make informed decisions. medication for adhd uk published in Molecular Psychiatry found that women who were taking ADHD medications during early pregnancy did not face an increased risk of fetal heart malformations or major birth defects that are structural. Researchers conducted a large population-based study of case-control to assess the risk of major structural birth defects in infants born to mothers who took stimulants during early pregnancy, and those who did not. Clinical geneticists and pediatric cardiologists examined the cases to ensure an accurate case classification and to minimize the chance of bias. The study of the researchers had some limitations. The researchers were unable in the beginning to differentiate the effects of the medication from the disorder. This makes it difficult to determine whether the limited associations observed in the exposed groups are due to the use of medication or the confounding effect of comorbidities. Additionally the study did not study long-term offspring outcomes. The study did find that babies whose mothers had taken ADHD medication during pregnancy were at a greater risk of being admitted to the neonatal intensive care unit (NICU) than infants who were born without any medication or taken off their medication prior to or during pregnancy. The reason for this was central nervous system disorders. The higher risk of admission was not affected by the stimulant medications used during pregnancy. Women who took stimulant ADHD medications during pregnancy also had a higher risk of having caesarean sections or 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 research suggests that the risk of a small amount with the use of ADHD medications during early pregnancy could be offset by the greater benefit to both mother and child of continued treatment for the woman's condition. Doctors should discuss with their patients about this issue and try to help them develop coping strategies that can lessen the effects of her disorder on her daily functioning and her relationships. Medication Interactions As more women than ever before are being diagnosed with ADHD and treated with medication, the question of whether to continue or end treatment during pregnancy is a question that doctors are having to face. Most of the time, these decisions are made without clear and authoritative evidence either way, so physicians must weigh their knowledge, the experiences of other doctors, and what the research suggests about the subject and their best judgment for each patient. In particular, the issue of potential risks for the baby can be tricky. Many of the studies on this topic are based on observational evidence rather than controlled research and their conclusions are often contradictory. medication for add adults restrict their analysis to live-births, which could underestimate the teratogenic impact which can cause abortions or terminations of pregnancy. The study that is discussed in this journal club addresses these limitations by examining data on both live and deceased births. Conclusion A few studies have found a positive correlation between ADHD medications and certain birth defects, other studies have not established a link. The majority of studies show that there is a neutral, or somewhat negative, effect. Therefore, a careful risk/benefit assessment must be conducted in every instance. It can be challenging, if not impossible for women suffering from ADHD to stop taking their medication. In a recent article 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 isolation. The loss of medication can also affect the ability to safely drive and to perform work-related tasks which are vital aspects of daily life for those suffering from ADHD. She suggests that women who are unsure about whether to keep or stop taking medication because of their pregnancy, consider informing family members, friends and colleagues on the condition, its effects on daily functioning, and on the benefits of keeping the current treatment plan. In addition, educating them can aid in ensuring that the woman feels supported when she is struggling with her decision. Certain medications can pass through the placenta. If the patient decides to not take her ADHD medication while breastfeeding, it is important to be aware that the drug could be transferred to the infant. Risk of Birth Defects As the use and use of ADHD drugs to treat symptoms of attention deficit hyperactivity disorder (ADHD) is increasing, so does concern about the potential effects of these drugs on foetuses. A study that was published in the journal Molecular Psychiatry adds to the body of knowledge on this subject. Utilizing two huge data sets researchers were able examine more than 4.3 million pregnancies and determine whether stimulant medications increased the risk of birth defects. Researchers discovered that although the risk overall is low, the first trimester ADHD medication exposure was associated with slightly higher risk of specific heart defects like ventriculoseptal defects. The authors of the study found no connection between the use of early medications and congenital abnormalities such as facial clefting or club foot. The results are consistent with previous studies that have shown the presence of a small, but significant increase in the risk of cardiac malformations among women who began taking ADHD medications prior to pregnancy. This risk increased during the latter half of pregnancy, when a lot of women began to stop taking their medication. Women who took ADHD medications in the first trimester of their pregnancies were also more likely to undergo caesarean section, low Apgar score following delivery, and a baby that required breathing assistance during birth. The authors of the study could not remove bias in selection since they limited their study to women who did not have any other medical conditions that might have contributed to the findings. Researchers hope their research will provide doctors with information when they meet pregnant women. The researchers suggest that while discussing risks and benefits are important, the choice about whether to continue or stop medication should be based on the severity of each woman's ADHD symptoms and her needs. The authors caution that, even though stopping the medication is a possibility to think about, it isn't advised because of the high incidence of depression and mental health issues for women who are pregnant or who have recently given birth. Further, the research suggests that women who decide to stop their medications are more likely to experience difficulties adapting to life without them following the baby's arrival. Nursing The responsibilities that come with being a new mother can be overwhelming. Women with ADHD may face a lot of challenges 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. This is why many women choose to continue taking their ADHD medication throughout the pregnancy. The majority of stimulant drugs pass through breast milk in very small quantities, so the risk to the infant who is breastfeeding is low. However, the amount of medication exposure to the infant can differ based on dosage, frequency it is administered and at what time the medication is administered. Additionally, individual medications enter the infant's system differently through the gastrointestinal tract as well as breast milk. The impact of this on a newborn is not yet fully known. Because of the lack of research, some doctors may be inclined to discontinue stimulant drugs during a woman's pregnancy. This is a difficult decision for the patient, who must balance the benefits of keeping her medication with the potential risks to the fetus. Until more information is available, doctors should ask all pregnant patients about their history of ADHD and whether they are taking or planning to take medication during the perinatal period. Numerous studies have proven that women can continue to take their ADHD medication without risk during pregnancy and breast-feeding. As a result, more and more patients are choosing to do so, and after consulting with their doctor, they have discovered that the benefits of keeping their current medication far outweigh any potential risks. It is crucial for women suffering from ADHD who are considering breastfeeding to seek out a specialist psychiatrist's advice prior to becoming pregnant. They should review their medications with their doctor and discuss the advantages and disadvantages of continued treatment, including non-pharmacological management strategies. Psychoeducation is also required to help pregnant women with ADHD recognize the signs and underlying disorder. They should also learn about treatment options and strengthen coping mechanisms. This should include an approach that is multidisciplinary, including the GP doctors, obstetricians and psychiatrists. Pregnancy counselling should include the discussion of a plan for management for both mother and child, and monitoring for signs of deterioration and when necessary, making adjustments to the medication regimen.