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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 medications may affect the fetus. A recent study published in Molecular Psychiatry shows that children exposed to ADHD medication in the uterus do not develop neurological conditions like hearing or vision impairment seizures, febrile seizures, or IQ impairment. The authors acknowledge that more high-quality studies are needed. Risk/Benefit Analysis Pregnant women who take ADHD medications need to balance the benefits of taking them against potential risks to the fetus. Doctors don't have enough data to make unambiguous recommendations however they can provide information about risks and benefits to help pregnant women make informed decisions. A study published in Molecular Psychiatry found that women who used ADHD medications in early pregnancy did not face a significantly increased risk of fetal cardiac malformations or major birth defects that are structural. Researchers used a large sample-based case control study to examine the prevalence of major structural defects in infants born to mothers who used stimulants during pregnancy. Pediatric cardiologists and clinical geneticists looked over the cases to ensure accurate case classification and to limit the possibility of bias. The study of the researchers was not without limitations. The most important issue was that they were not able to differentiate the effects of the medication from the effects of the disorder that is underlying. This limitation makes it difficult for researchers to determine if the few associations observed between the exposed groups were due to medication use or caused by co-morbidities. Additionally the researchers did not examine the long-term outcomes of 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 those whose mothers had not taken any medication or had taken off their medication prior to or during pregnancy. This was due to central nervous system-related disorders and the increased risk for admission was not found to be affected by the type of stimulant medications were taken during pregnancy. Women who took stimulant ADHD medication during pregnancy were also at an elevated risk of having a caesarean birth or having a baby with a low Apgar score (less than 7). These increases did appear to be unrelated to the type of medication taken during pregnancy. The researchers suggest that the small risk associated with the use of ADHD medications during early pregnancy could be offset by the higher benefit to both mother and child from continued treatment for the woman's disorder. Physicians should discuss this with their patients and, if possible, help them develop strategies to improve coping skills that can lessen the impact of her disorder on her daily functioning and relationships. adhd medication adults are faced with the decision of whether to maintain treatment or stop it during pregnancy as more women are diagnosed with ADHD. These decisions are often made without clear and authoritative evidence. Instead, doctors must take into account their own experience and experience, as well as the experiences of other doctors, and the research on the topic. The issue of possible risks to the infant can be difficult to determine. The research on this issue is based on observations rather than controlled studies and the results are conflicting. Furthermore, most studies restrict their analysis to live births, which may undervalue the serious teratogenic effects that can cause abortion or termination of the pregnancy. The study discussed in the journal club addresses these limitations, by examining both information on deceased and live births. Conclusion A few studies have found an association between ADHD medications and certain birth defects However, other studies haven't established a link. Most studies show an unintended, or slightly negative, effect. Therefore, a careful risk/benefit analysis is required in every situation. For women suffering from ADHD, the decision to stop medication is 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 increase depression, feelings of isolation, and family conflict for these patients. Furthermore, a 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 unsure about whether to keep or discontinue medication due to their pregnancy consider the possibility of educating friends, family members and colleagues on the condition, its effects on daily functioning, and the benefits of keeping the current treatment regimen. It can also help women feel confident about her decision. It is important to remember that certain medications are able to pass through the placenta so if a woman decides to discontinue her ADHD medication during pregnancy and breastfeeding, she should be aware that the effects of the drug can be passed on to the baby. Risk of Birth Defects As the use of ADHD medications to treat symptoms of attention deficit hyperactivity disorder (ADHD) grows, so do concerns over the impact that these drugs might have on fetuses. A study that was published in the journal Molecular Psychiatry adds to the existing knowledge about this subject. With two massive data sets, researchers were able to analyze more than 4.3 million pregnancies to determine whether stimulant medications increased the risk of birth defects. Although the risk overall remains low, the scientists discovered that the first-trimester exposure to ADHD medications was associated with an increased risk of certain heart defects such as ventriculoseptal defect (VSD). The researchers of the study didn't discover any link between early use of medication and other congenital anomalies, like facial deformities, or club feet. The results are consistent with previous studies revealing a small but significant increase in the risk of heart malformations among women who started taking ADHD medications prior to the birth of their child. The risk increased in the latter half of pregnancy when a large number of women stopped taking their medication. Women who took ADHD medications during the first trimester of pregnancy were also more likely to experience caesarean sections, a low Apgar score following delivery, and a baby who needed help breathing at birth. The authors of the study were not able to remove bias in selection since they limited their study to women without other medical conditions that could have contributed to the findings. The researchers hope their study will aid in the clinical decisions of doctors who see pregnant women. They suggest that although discussing the risks and benefits is crucial 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 also warn that even though stopping the medication is an option, it isn't a recommended practice because of the high incidence of depression and other mental health problems for women who are expecting or who are recently post-partum. Additionally, research suggests that women who stop taking their medications will have a difficult adjustment to life without them once the baby is born. Nursing It can be a stressful experience becoming a mother. Women who suffer from ADHD can face severe challenges when they must manage their symptoms, attend doctor appointments and prepare for the birth of their child and adjust to new routines. Many women opt to continue taking their ADHD medication during pregnancy. The risk for nursing infant is low because the majority of stimulant medication passes through breast milk in low amounts. However, the frequency of exposure to medication by the infant can differ based on the dosage, frequency it is taken and the time of the day it is administered. In addition, different medications enter the baby’s system through the gastrointestinal tract or through breast milk. The impact of these medications on a newborn's health is not completely understood. Some doctors may decide to stop stimulant medication during a woman's pregnancy due to the absence of research. It's a difficult choice for the mother, who must weigh the benefits of taking her medication as well as the potential risks to the foetus. As long as there is no more information, GPs should ask all pregnant patients about their history of ADHD and if they plan or are taking to take medication during the perinatal time. Numerous studies have demonstrated that women can continue to take their ADHD medication without risk during pregnancy and breast-feeding. In response, a growing number of patients are choosing to do this. They have concluded through consultation with their physicians that the benefits of keeping their current medication outweigh any potential risks. It is essential for women with ADHD who are contemplating breastfeeding to seek out a specialist psychiatrist's guidance prior to becoming pregnant. They should discuss their medication with their doctor and discuss the pros and cons of continuing treatment. This includes non-pharmacological strategies. Psychoeducation should also be offered to help women with ADHD recognize their symptoms and underlying disorder and learn about treatment options and reinforce existing strategies for managing. This should be a multidisciplinary approach with the GPs, obstetricians 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 regime.