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ADHD Medication During Pregnancy and Breastfeeding The choice of whether to stop or continue ADHD medications during pregnancy and nursing is challenging for women with the condition. Little data exists about how long-term exposure to these drugs can affect the foetus. A recent study published in Molecular Psychiatry shows that children exposed to ADHD medication during utero do not develop neurological developmental conditions like hearing or vision impairment seizures, febrile seizures, or IQ impairment. The authors acknowledge that further high-quality research is needed. Risk/Benefit Analysis Women who are pregnant and take ADHD medication should evaluate the benefits of using it versus the risks to the baby. Physicians don't have the necessary data to give clear guidelines, but they can provide information about the risks and benefits to 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 a higher risk of fetal malformations, or structural birth defects. Researchers conducted a large population-based study of case control to compare the incidence of structural defects that were major in infants born to mothers who took stimulants during pregnancy. Clinical geneticists and pediatric cardiologists reviewed the cases to ensure an accurate classification of the cases and to reduce the possibility of bias. However, the researchers' study was not without its flaws. The researchers were not able, in the first place to distinguish the effects triggered by the medication from the disorder. This limitation makes it difficult for researchers to determine whether the small differences observed between the groups exposed were due to medication use or confounded by comorbidities. The researchers did not examine long-term outcomes for the offspring. The study did find that infants whose mothers had taken ADHD medication during pregnancy were at a more risk of being admitted to the neonatal intensive care unit (NICU) than infants whose mothers had not taken any medication or had cut back on their medications prior to or during pregnancy. This increase was due to central nervous system-related disorders and the increased risk for admission did not appear to be influenced by the stimulant medication was used during pregnancy. Women who were taking stimulant ADHD medications during pregnancy also had a higher chance of having a caesarean section or one whose baby scored low on the Apgar scale (less than 7). These increases did appear to be independent of the type of medication used during pregnancy. The research suggests that the low risk associated with the use of ADHD medications during the early stages of pregnancy may be offset by the greater benefit to both mother and child from continued treatment for the woman's condition. Doctors should discuss with their patients about this and, if possible, help them develop coping skills that may reduce the impact of her disorder in her daily functioning and her relationships. Medication Interactions Many doctors are confronted with the dilemma of whether to keep treatment or stop during pregnancy as more women are diagnosed with ADHD. These decisions are frequently made without clear and authoritative evidence. Instead, doctors have to take into account their own experience in conjunction with the experiences of other doctors and the research on the subject. The issue of possible risks to infants is particularly tricky. Many studies on this topic are based on observational data instead of controlled research and their conclusions are often contradictory. Furthermore, most studies restrict their analysis to live births, which can underestimate the severity of teratogenic effects that could lead to abortion or termination of the pregnancy. The study discussed in this journal club addresses these shortcomings 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 shown such a relationship. Most studies show a neutral, or even slight negative effect. In each case an in-depth study of the potential risks and benefits must be performed. 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 increase depression and feelings of loneliness. A loss of medication may affect the ability to safely drive and complete work-related tasks, which are vital aspects of everyday life for those suffering from ADHD. She suggests that women who are unsure whether to continue taking medication or discontinue it due to pregnancy educate family members, colleagues, and acquaintances about the condition, its impact on daily functioning and the advantages of staying on the current treatment regimen. It will also help a woman feel more confident in her decision. Certain medications can be passed through the placenta. If the patient decides to not take her ADHD medication while breastfeeding, it is crucial to be aware that the drug may be transferred to her infant. Risk of Birth Defects As the use of ADHD drugs to treat symptoms of attention deficit hyperactivity disorder (ADHD) grows, so do concerns over the impact that these drugs could have on foetuses. A study that was published in the journal Molecular Psychiatry adds to the existing knowledge about this subject. Researchers used two massive data sets to examine more than 4.3 million pregnant women and determine if stimulant medication use increased the risk of birth defects. Although the risk overall is low, the researchers found that exposure in the first trimester to ADHD medications was associated with an increase in the risk of specific heart defects, such as ventriculoseptal defect (VSD). The authors of the study did not find any association between the use of early medications and congenital anomalies like facial deformities, or club feet. The results are in agreement with previous studies that have shown a small, but significant increase in the number of cardiac malformations among women who began taking ADHD medication prior to the time of pregnancy. The risk increased in the latter stages of pregnancy when many women stopped taking their medication. Women who took ADHD medications in the first trimester of their pregnancy were also more likely to experience caesarean section, low Apgar score following delivery, and a baby who required breathing assistance during 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 conditions that could be a contributing factor to these findings. The researchers hope their research will help inform the clinical decisions of doctors who see pregnant women. They suggest that although a discussion of the benefits and risks is important but the decision to stop or keep medication must be based on each woman's requirements and the severity of her ADHD symptoms. The authors warn that, although stopping the medication is a possibility to consider, it is not advised due to the high prevalence of depression and mental health issues in women who are expecting or have recently given birth. Furthermore, research suggests that women who choose to stop their medications are more likely to experience difficulties adjusting to life without them after the baby's arrival. Nursing The responsibilities that come with being a new mom can be overwhelming. medications for adhd in adults with ADHD who must work through their symptoms while attending doctor appointments and making preparations for the arrival of a baby and adjusting to new household routines may face a lot of challenges. Many women decide to continue taking their ADHD medication during pregnancy. The majority of stimulant medicines pass through breast milk in small quantities, so the risk to infant who is breastfeeding is low. The rate of exposure to medication will differ based on dosage, frequency of administration and time of day. Additionally, different medications enter the infant's system differently through the gastrointestinal tract as well as breast milk, and the effect of this on a newborn infant is not well known. Some doctors may stop taking stimulant medication during a woman’s pregnancy due to the lack of research. This is a difficult decision for the woman who must weigh the advantages of continuing her medication against the potential risks to the embryo. Until more information becomes available, doctors can inquire about pregnant patients if they have a history of ADHD or if they are planning to take medication in the perinatal stage. A increasing number of studies have proven that women can continue to take their ADHD medication during pregnancy and breastfeeding. This has led to more and more patients are choosing to do so, and after consulting with their doctor, they have found that the benefits of maintaining their current medication exceed any risk. It is crucial for women suffering from ADHD who are considering breastfeeding to seek a specialist psychiatrist's advice prior to becoming pregnant. They should discuss the medication they are taking with their physician, and the pros and cons of continuing treatment. This includes non-pharmacological strategies. Psychoeducation is also required to help pregnant women suffering from ADHD be aware of their symptoms and the root cause and learn about treatment options and reinforce existing strategies for coping. This should involve a multidisciplinary approach, which includes the GP, obstetricians and psychiatry. Pregnancy counseling should consist of a discussion of a treatment plan for the mother and child, as well as monitoring for signs of deterioration and, if necessary adjustments to the medication regime.