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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 a challenge for women suffering from the condition. There are www.iampsychiatry.uk on how long-term exposure may affect a foetus. A study recently published in Molecular Psychiatry shows that children exposed to ADHD medication in the uterus do not develop neurological developmental disorders such as hearing loss or impaired vision seizures, 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 must weigh the benefits of taking it versus the risks to the foetus. Physicians do not have the necessary data 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 were taking ADHD medication during their early pregnancy did not have a higher risk of fetal malformations or structural birth defects. The researchers used a large, population-based case-control study to assess the risk of major structural birth defects in babies born to mothers who took stimulants during the early stages of pregnancy and those who had not. Pediatric cardiologists, clinical geneticists and other experts reviewed the cases in order to ensure that the classification was accurate and to minimize any bias. The study conducted by the researchers was not without limitations. The most important issue was that they were unable to distinguish the effects of the medication from the disorder that is underlying. That limitation makes it difficult to determine whether the small differences observed in the groups that were exposed are due to the use of medication or comorbidities that cause confusion. Additionally the researchers did not look at the long-term outcomes of offspring. The study did show that babies whose mothers had taken ADHD medication during pregnancy were at a more risk of being admitted to the neonatal intensive care unit (NICU) than those who were born without any medication or had cut back on their medications prior to or during pregnancy. This increase was due to central nervous system disorders, and the increased risk for admission did not appear to be affected by the type of stimulant medications were used during pregnancy. Women who were taking stimulant ADHD medications during pregnancy also had a higher likelihood of having caesarean sections or the baby was not scoring well on the Apgar scale (less than 7). These increases did not appear to be affected by the type of medication that was used during pregnancy. Researchers suggest that the minor risks associated with the use 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 and try to help them improve coping skills which can lessen the effects of her disorder on her daily life and relationships. Interactions with Medication As more women than ever are being diagnosed with ADHD and being treated with medication, the dilemma of whether or not to end treatment during pregnancy is a question that more and more doctors face. These decisions are frequently taken without clear and authoritative evidence. Instead, doctors must weigh their own knowledge in conjunction with the experiences of other physicians and the research on the topic. The issue of potential risks to the infant can be difficult to determine. A lot of studies on this topic are based on observational data rather than controlled research and their conclusions are often contradictory. Additionally, the majority of studies limit their analysis to live births, which can undervalue the serious teratogenic effects that can lead to abortion or termination of the pregnancy. The study that is discussed in this journal club addresses these issues by examining data on both live and deceased births. Conclusion: While some studies have found an association between ADHD medications and certain birth defects, other studies have not found a correlation. The majority of studies show a neutral, or even slightly negative, impact. In all cases, a careful analysis of the potential risks and benefits is required. It isn't easy, but not impossible for women suffering from ADHD to stop taking their medication. In a recent article published 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. In addition, a decrease in medication can interfere with the ability to perform job-related tasks and drive safely, which are important aspects of a normal life for many people suffering from ADHD. She suggests that women who are unsure whether to continue taking the medication or stop it due to their pregnancy, educate their family members, coworkers and acquaintances about the condition, its effects on daily functioning, and the benefits of continuing the current treatment regimen. In addition, educating them can make the woman feel more comfortable as she struggles with her decision. It is also worth noting 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 traces of the drug could be transferred to the child. Birth Defects and Risk of As the use and use of ADHD drugs to treat symptoms of attention deficit hyperactivity disorder (ADHD), increases as does the concern about the possible effects of the drugs on the fetuses. A study that was published in the journal Molecular Psychiatry adds to the existing knowledge on this subject. Researchers used two massive data sets to study more than 4.3 million pregnant women and determine if stimulant medication use increased birth defects. Researchers found that while the overall risk is low, the first trimester ADHD exposure to medication was associated with slightly higher risk of specific heart defects like ventriculoseptal defect. The researchers behind the study found no connection between early medication use and congenital abnormalities like facial clefting, or club foot. The results are consistent with previous studies showing the presence of a small, but significant increase in the risk of heart malformations among women who began taking ADHD medications prior to pregnancy. The risk increased in the latter half of pregnancy when a large number of women stopped taking their medication. Women who took ADHD medication in the first trimester were more likely to require a caesarean delivery or have a low Apgar after delivery, and have a baby that needed help breathing after birth. However the authors of the study were not able to eliminate bias due to selection by limiting the study to women who did not have any other medical issues that could be a contributing factor to these findings. Researchers hope that their research will provide doctors with information when they meet pregnant women. They recommend that, while discussing the risks and benefits is crucial however, the decision to stop or maintain medication should be based on each woman's needs and the severity of her ADHD symptoms. The authors caution that, while stopping the medication is an option to look into, it is not recommended due to the high prevalence of depression and other mental problems in women who are expecting or recently gave birth. Additionally, the research suggests that women who decide to stop taking their medication are more likely to experience difficulties adapting to life without them following the birth of their baby. Nursing The responsibilities of a new mother can be overwhelming. Women with ADHD who have to deal with their symptoms while attending physician appointments as well as making preparations for the arrival of a child and getting used to new routines at home may face a lot of challenges. Many women decide to continue taking their ADHD medication during pregnancy. The risk to a breastfeeding infant is minimal because the majority of stimulant medication is absorbed through breast milk at low levels. However, the frequency of medication exposure to the newborn may differ based on dosage, frequency it is taken and at what time the medication is administered. In addition, individual medications enter the baby's system differently through the gastrointestinal tract and breast milk and the impact of this on a newborn infant is not fully understood. Because of the lack of research, some doctors might be tempted to stop taking stimulant medications during the course of pregnancy. This is a difficult choice for the patient, who must balance the benefits of keeping her medication against the potential risks to the fetus. Until more information is available, doctors should inquire with all pregnant patients about their history of ADHD and whether they are planning or taking to take medication during the perinatal period. Numerous studies have proven that women can continue taking their ADHD medication in a safe manner during pregnancy and while breast-feeding. In response, an increasing number of patients are opting to do so. They have concluded after consulting with their physicians that the benefits of retaining their current medication outweigh any potential risks. Women with ADHD who are planning to nurse should seek advice from a specialist psychiatrist prior to becoming pregnant. They should discuss their medication with their physician and discuss the pros and cons of continued treatment, including non-pharmacological management strategies. Psychoeducation should also be provided to help women with ADHD understand their symptoms and underlying disorder Learn about the available treatment options and reinforce existing strategies for managing. This should be a multidisciplinary approach with the GPs, obstetricians and psychiatrists. Counselling for pregnancy should include the discussion of a plan for management for both the mother as well as the child, and monitoring for signs of deterioration, and, if necessary, adjustments to the medication regimen.