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ADHD Medication During Pregnancy and Breastfeeding The decision to stop or keep ADHD medications during breastfeeding and pregnancy is challenging for women with the condition. There are few data on how exposure to ADHD for a long time could affect the fetus. A recent study published in Molecular Psychiatry shows that children exposed to ADHD medication in the uterus do not develop neurological developmental disorders such as hearing or vision impairment seizures, febrile seizures or IQ impairment. The authors acknowledge that more high-quality studies are needed. Risk/Benefit Analysis Women who are pregnant and take ADHD medication should weigh the benefits of taking it against the potential risks to the foetus. Physicians don't have the necessary data to provide clear recommendations however they can provide information regarding benefits and risks that can assist pregnant women in making informed decisions. A study published in Molecular Psychiatry found that women who took ADHD medications during early pregnancy did not face an higher risk of fetal cardiac malformations or major birth defects that are structural. Researchers used a vast population-based study of case-control to assess the risk of major structural birth defects in babies born to mothers who had taken stimulants during the early stages of pregnancy, as well as those who had not. Pediatric cardiologists, clinical geneticists and other experts looked over the cases to make sure that the classification was accurate and to minimize any bias. The study conducted by the researchers was not without its limitations. The researchers were not able to, in the first place to distinguish the effects triggered by the medication from the disorder. This limitation makes it difficult for researchers to establish whether the few associations observed between the groups exposed were due to the use of medications, or if they were confounded by co-morbidities. Researchers also did not examine long-term outcomes for offspring. The study did show that infants whose mothers had taken ADHD medication during pregnancy were at a slightly higher risk of being admitted to the neonatal intensive care unit (NICU) than those whose mothers had not taken any medication or stopped their medications before or during pregnancy. This was due to central nervous system-related disorders and the increased risk for admission was not found to be influenced by the stimulant medication was used during pregnancy. Women who were taking stimulant ADHD medication during pregnancy also had an increased risk of having a caesarean delivery or having a child with low Apgar score (less than 7). These increases appeared to be unrelated to the type of medication taken during pregnancy. Researchers suggest that the minor risks posed by the use of ADHD medication during pregnancies in the early stages may be offset by the greater benefits to both mother and baby from 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. Interactions with Medication More and more doctors are faced with the decision of whether to continue treatment or stop as more women are diagnosed with ADHD. Often, these decisions are made in the absence of solid and reliable evidence regardless, so doctors have to weigh their experience from their own experiences, those of other doctors, and what the research suggests about the subject and their own judgments for each patient. The issue of potential risks for infants can be particularly tricky. Many studies on this issue are based on observational evidence instead of controlled research and their conclusions are often contradictory. In addition, most studies limit their analysis to live births, which may undervalue the serious teratogenic effects that can cause abortion or termination of the pregnancy. The study presented in the journal club addresses these limitations by analyzing the data from deceased and live births. Conclusion Some studies have found an association between ADHD medications and certain birth defects, other studies have not shown such a relationship. Most studies have shown a neutral, or even slight negative effect. In the end, a careful risk/benefit analysis is required in every case. It isn't easy, but not impossible for women with ADHD to stop taking their medication. In a recent article published 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 isolation. In medication for add adults , a decrease in medication may affect the ability to do work-related tasks and safely drive that are crucial aspects of a normal life for a lot of people with ADHD. She suggests that women who are unsure about whether to continue or stop taking medication because of their pregnancy consider informing family members, friends and colleagues about the condition, its effects on daily life, and the benefits of keeping the current treatment regimen. Educating them can also aid in ensuring that the woman feels supported as she struggles with her decision. Certain medications can pass through the placenta. If a patient decides not to take her ADHD medication while pregnant and breastfeeding, it's important to be aware that the medication could be passed on to her baby. Risk of Birth Defects As the use of ADHD medications to treat symptoms of attention deficit hyperactivity disorder (ADHD) increases as do concerns about the effects that the drugs might have on foetuses. Recent research published in the journal Molecular Psychiatry has added to the body of knowledge on this subject. Researchers utilized two massive data sets to study more than 4.3 million pregnancy and determine if the use of stimulant medications caused birth defects. Although the risk overall remains low, the scientists did find that first-trimester exposure to ADHD medicines was associated with an increased risk of certain heart defects such as ventriculo-septal defect (VSD). The researchers of the study didn't discover any link between the use of early medications and congenital anomalies like facial deformities or club feet. The results are in line with previous studies that showed an insignificant, but small increase in the number of cardiac malformations among women who began taking ADHD medication prior to pregnancy. The risk increased in the latter stages of pregnancy when many women stopped taking their medication. Women who used ADHD medications during the first trimester of their pregnancies were also more likely to undergo caesarean section, low Apgar score following delivery, and a baby who needed help breathing at birth. However, the authors of the study were not able to eliminate selection bias by limiting the study to women who did not have other medical issues that could have contributed to the findings. Researchers hope that their research will help doctors when they meet pregnant women. linked web page suggest that while discussing the risks and benefits are important, the decision regarding whether or not to stop medication should be based on the severity of each woman's ADHD symptoms and the needs of the woman. The authors caution that, even though stopping the medication is an option to think about, it isn't advised because of the high incidence of depression and other mental disorders among women who are pregnant or have recently given birth. Research has also shown that women who stop taking their medications will have a difficult time adjusting to a life without them once the baby is born. Nursing It can be overwhelming to become a mom. Women who suffer from ADHD who must work through their symptoms while attending physician appointments, preparing for the arrival of a baby and adjusting to new household routines can experience severe challenges. This is why many women decide to continue taking their ADHD medication throughout the pregnancy. The risk to a breastfeeding infant is not too high since the majority of stimulant medications passes through breast milk in low amounts. However, the amount of exposure to medications by the newborn may differ based on dosage, how often it is administered and at what time it is administered. In addition, various medications enter the baby’s system through the gastrointestinal tract, or through breast milk. The effect on a newborn's health is not fully understood. Because of the lack of research, some physicians may recommend stopping stimulant medication during the pregnancy of a woman. This is a difficult choice for the patient, who must weigh the benefits of keeping her medication against the potential dangers to the fetus. Until more information becomes available, GPs can inquire about pregnant patients whether they have a history of ADHD or if they intend to take medication in the perinatal period. Numerous studies have demonstrated that women can continue taking their ADHD medication without risk during pregnancy and while breast-feeding. In response, an increasing number of patients are choosing to do this. They have discovered, in consultation with their doctors that the benefits of continuing their current medication outweigh any possible risks. It's important for women with ADHD who are contemplating breastfeeding to seek out a specialist psychiatrist's guidance prior to becoming pregnant. They should review their medications with their doctor and discuss the pros and cons of continued treatment, including non-pharmacological strategies. Psychoeducation is also required to help pregnant women suffering from ADHD be aware of the symptoms and underlying disorder. They should also learn about treatment options and build the coping mechanisms. This should be a multidisciplinary approach together with obstetricians, GPs and psychiatry. Pregnancy counseling should include discussion of a treatment plan for the mother and the child, monitoring of signs of deterioration, and, if necessary adjustments to the medication regimen.