ADHD Medication During Pregnancy and Breastfeeding Women with ADHD must make a difficult decision about whether to continue or stop taking ADHD medication during pregnancy and breastfeeding. Little data exists about how long-term exposure to these drugs can affect the foetus. A study recently published in Molecular Psychiatry shows that children exposed to ADHD medication during utero do not develop neurological developmental disorders like impaired vision or hearing 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 must consider the benefits of taking it against the potential risks for the baby. Physicians do not have the data needed to make unequivocal recommendations, but they can provide information regarding risks and benefits that aid pregnant women in making informed choices. A study published in Molecular Psychiatry concluded that women who were taking ADHD medication in early pregnancy were not at a higher risk of fetal malformations or structural birth defects. Researchers used a vast, population-based case-control study to determine the prevalence of major structural birth defects in babies born to mothers who took stimulants during the early stages of pregnancy, and those who did not. Clinical geneticists, pediatric cardiologists and other experts reviewed the cases in order to make sure that the classification was correct and to minimize any bias. The study conducted by the researchers had some limitations. The researchers were unable to, in the first place, to separate the effects triggered by the medication from the disorder. This limitation makes it difficult for researchers to determine whether the few associations observed between the groups exposed were due to the use of medications or caused by comorbidities. The researchers also did not examine the long-term effects for the offspring. The study did find that infants whose mothers had taken ADHD medications during pregnancy were at slightly higher risk of being admitted to the neonatal intensive care unit (NICU) than infants who were born without any medication or had stopped their medications before or during pregnancy. This increase was due to central nervous system disorders, and the increased risk for admission did not appear to be influenced by the stimulant medications were taken during pregnancy. Women who were taking stimulant ADHD medications during pregnancy also had a higher likelihood of having to have a caesarean section or a baby that scored low on the Apgar scale (less than 7). These increases did appear to be unrelated to the type of medication taken during pregnancy. The researchers suggest that the low risk associated with the use of ADHD medications during the early stages of pregnancy could be offset by the greater benefit to both mother and child of continued treatment for the woman's disorder. Physicians should discuss this with their patients and, when they are able, assist them in developing strategies to improve their coping abilities that may minimize the negative impact of her condition on her daily functioning and relationships. Interactions with Medication Many doctors are confronted with the dilemma of whether to continue treatment or stop it during pregnancy as more women are diagnosed with ADHD. These decisions are frequently made without clear and authoritative evidence. Instead, doctors have to weigh their own knowledge in conjunction with the experiences of other doctors, and the research that has been conducted on the subject. The issue of potential risks to the infant can be particularly tricky. Many studies on this subject are based on observational data instead of controlled research and their conclusions are often contradictory. The majority of studies restrict their analysis to live births, which may underestimate the severity of teratogenic effects that can lead to abortions or terminations of pregnancy. The study that is discussed in this journal club addresses these limitations by looking at data from both live and deceased births. The conclusion The conclusion: While certain studies have demonstrated an association between ADHD medications and the possibility of certain birth defects, others have found no such relationship and the majority of studies have a neutral or slightly negative effect. In the end an accurate risk-benefit analysis must be conducted in every situation. For women suffering from ADHD and ADD, the decision to discontinue medication can be difficult, if not impossible. In a recent article 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 loneliness and family conflict for these patients. Additionally, the loss of medication can affect the ability to perform jobs and drive safely that are crucial aspects of daily life for many people suffering from ADHD. She recommends women who are uncertain about whether to keep or stop medication in light of their pregnancy consider educating family members, friends and colleagues about the condition, its impact on daily life, and the advantages of staying on the current treatment plan. In addition, educating them can help the woman feel supported when she is struggling with her decision. It is important to note that certain drugs can pass through the placenta, so if a woman decides to stop taking her ADHD medication during pregnancy and breastfeeding, she must be aware of the possibility that traces of the drug could be transferred to the child. Birth Defects and Risk of As the use and abuse 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 about this subject. Researchers used two huge datasets to analyze over 4.3 million pregnancies and determine whether stimulant medications increased birth defects. Researchers discovered that, while the risk overall is low, first-trimester ADHD exposure to medication was associated with slightly higher rates of specific heart defects such as ventriculoseptal defect. The authors of the study did not find any association between the use of early medications and other congenital anomalies like facial deformities or club feet. The findings are in line with previous studies revealing the presence of a small, but significant increase in the risk of heart malformations among women who started taking ADHD medications prior to the time of pregnancy. The risk increased in the latter part of pregnancy when many women stopped taking their medication. Women who used ADHD medication in the first trimester of their pregnancies were also more likely to experience caesarean section, low Apgar score after delivery and a baby who needed breathing assistance at birth. The authors of the study were not able to eliminate selection bias because they limited the study to women with no other medical conditions that could have contributed to the findings. best adhd medication hope their research will inform physicians when they meet pregnant women. They suggest that although a discussion of risks and benefits is important but the decision to stop or maintain treatment 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 rate 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 difficult adjustment to life without them once the baby is born. Nursing It can be overwhelming to become a mom. Women with ADHD who have to manage their symptoms while attending doctor appointments as well as preparing for the arrival of a child and getting used to new routines at home are often faced with a number of difficulties. This is why many women elect to continue taking their ADHD medications throughout pregnancy. The majority of stimulant drugs pass through breast milk in small amounts, therefore the risk to nursing infant is very low. However, the rate of exposure to medications by the newborn can vary depending on the dosage, frequency it is administered and the time of the day it is administered. In addition, different medications enter the baby’s system through the gastrointestinal tract or breast milk. The impact on a newborn's health is not fully comprehended. Some doctors may decide to stop stimulant medication during a woman's pregnancy due to the absence of research. This is a difficult decision for the woman who must weigh the benefits of taking her medication as well as the potential risks to the embryo. Until more information is available, doctors should ask 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 demonstrated that women can continue taking their ADHD medication without risk during pregnancy and breast-feeding. This has led to an increasing number of patients opt to do this and in consultation with their physician, they have discovered that the benefits of continuing their current medication 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 discuss the medication they are taking with their physician, and the pros and cons of continuing treatment. This includes non-pharmacological methods. Psychoeducation should also be offered to help women with ADHD be aware of their symptoms and the underlying disorder, learn about available treatments and to reinforce existing strategies for coping. This should be a multidisciplinary process including obstetricians, GPs, and psychiatrists. Pregnancy counseling should include a discussion of a treatment plan for the mother and child, and monitoring for signs of deterioration, and, if necessary, adjustments to the medication regime.
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