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ADHD Medication During Pregnancy and Breastfeeding

Women suffering from ADHD have to make a difficult choice on whether to keep or stop taking ADHD medication during pregnancy and breast-feeding. Little data exists about how long-term exposure to these medications could affect the fetus.

A recent study published in Molecular Psychiatry shows that children exposed to ADHD medication in utero do not develop neurological conditions like hearing or vision impairment, febrile seizures, or IQ impairment. The authors acknowledge the need for higher-quality studies.

Risk/Benefit Analysis

Pregnant women who use ADHD medications need to balance the benefits of using them against the risks to the fetus. Physicians do not have the information needed to provide clear recommendations, but they can provide information regarding risks and benefits that 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 increased risk of fetal cardiac malformations or major structural birth defects. Researchers conducted a large population-based study of case control to examine the prevalence of structural defects that were major in infants who were born to mothers who took stimulants during pregnancy. Clinical geneticists and pediatric cardiologists reviewed the cases to ensure correct case classification and to minimize the possibility of bias.

However, the study was not without its flaws. In particular, they were unable to separate the effects of the medication for adhd from the underlying disorder. This limitation makes it difficult to determine whether the small differences observed in the exposed groups are due to medication use or comorbidities that cause confusion. Additionally the researchers did not look at the long-term effects of offspring on their parents.

The study showed that infants whose mother had taken ADHD medication during pregnancy had a slightly greater risk of being admitted to the neonatal care unit (NICU) in comparison to those whose mothers did not take any medication for inattentive adhd and anxiety during pregnancy or had discontinued taking their medication prior to or during pregnancy. The reason for this was central nervous system disorders. The higher risk of admission was not affected by the stimulant medications used during pregnancy.

Women who used stimulant ADHD medication during pregnancy were also at an increased chance of having a caesarean delivery or having a baby born with an low Apgar score (less than 7). These increases 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 may be offset by the higher benefit to both the mother and child of continued treatment for the woman's disorder. Physicians should discuss the issue with their patients and, if possible, help them develop strategies to improve coping skills that can lessen the effects of her disorder on her daily functioning and relationships.

Medication Interactions

As more women than ever before are being diagnosed with ADHD and being treated with medication, the dilemma of whether to continue or stop treatment during pregnancy is a question that doctors are having to have to face. These decisions are often made without clear and reliable evidence. Instead, doctors must consider their own expertise, the experience of other doctors and the research on the subject.

In particular, the issue of potential risks to the infant can be difficult. A lot of studies on this issue are based on observational data instead of controlled research and their findings are often contradictory. The majority of studies focus on live births, which may underestimate the teratogenic impact leading to abortions or terminations of pregnancy. The study discussed in the journal club addresses these issues by analyzing both the data from deceased and live births.

The conclusion: While some studies have found an association between ADHD medications and the risk of certain birth defects, others have found no connection and the majority of studies have a neutral or slight negative effect. In every case an in-depth study of the risks and benefits must be performed.

For a lot of women with ADHD, the decision to stop taking medication is difficult if not impossible. In fact, in an article recently published 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 isolation, and family conflict for those suffering from the disorder. A loss of medication may also affect the ability to safely drive and to perform work-related tasks which are essential aspects of daily life for those with ADHD.

She suggests that women who are unsure whether to continue taking the medication or stop due to pregnancy should educate family members, coworkers and their friends about the condition, the effects 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. It is important to note that certain medications can be absorbed through the placenta so if the patient decides to stop her ADHD medication during pregnancy and breastfeeding, she should be aware of the possibility that traces of the medication could be transferred to the child.

Birth Defects and Risk of

As the use and misuse of ADHD drugs to treat symptoms of attention deficit hyperactivity disorder (ADHD) increases the concern over the possible effects of the drugs on foetuses. Recent research published in the journal Molecular Psychiatry has added to the body of knowledge on this issue. Researchers used two massive datasets to analyze more than 4.3 million pregnancy and determine if the use of stimulant medications increased birth defects. Researchers discovered that, while the overall risk is low, the first trimester ADHD medication use was associated with slightly higher rates of certain heart defects, like ventriculoseptal defects.

The researchers of the study found no association between the use of early medications and congenital abnormalities like facial clefting, or club foot. The findings are in line with previous studies that have shown the presence of a small, but significant increase in the risk of cardiac malformations in women who started taking ADHD medications before the time of pregnancy. The risk was higher in the latter half of pregnancy, when a lot of women decide to stop taking their ADHD medication.

Women who took ADHD medication in the first trimester were more likely need a caesarean, have an insufficient Apgar after birth and have a baby that needed breathing assistance at birth. However the researchers of the study were unable to eliminate bias due to selection by restricting the study to women who didn't have any other medical conditions that could have contributed to these findings.

The researchers hope their research will help inform the clinical decisions of physicians who encounter pregnant women. They recommend that, while a discussion of the risks and benefits is crucial 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, while stopping the medication is a possibility to think about, it isn't advised because of the high incidence of depression and other mental problems for women who are pregnant or who have recently given birth. Further, research shows that women who stop taking their medications will have a tough transitioning to life without them after the baby is born.

Nursing

The responsibilities that come with being a new mother can be overwhelming. Women with ADHD who have to deal with their symptoms while attending physician appointments, preparing for the arrival of a baby and getting used to new routines at home are often faced with a number of difficulties. Many women decide to continue taking their ADHD medication during pregnancy.

The majority of stimulant drugs are absorbed by breast milk in very small amounts, therefore the risk to the breastfeeding infant is minimal. The amount of exposure to medications will vary based on the dosage the medication is administered, its frequency and the time of the day. In addition, different drugs enter the infant's system through the gastrointestinal tract, or through breast milk. The impact of these medications on the health of a newborn is not completely comprehended.

Some doctors may stop taking stimulant medication during a woman's pregnancy due to the absence of research. It is a difficult decision for the woman, who must weigh the benefits of her best medication for inattentive adhd against 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 whether they are planning or taking to take medication during the perinatal time.

A growing number of studies have proven that most popular adhd medication women can safely continue to take their ADHD medication during pregnancy and breastfeeding. As a result, more and more patients choose to do so and, after consulting with their doctor, they have discovered that the benefits of maintaining their current medication outweigh any risks.

It is crucial for women suffering from ADHD who are contemplating breastfeeding to seek out a specialist psychiatrist's advice prior becoming pregnant. They should discuss their medication with their prescriber as well as the pros and cons for continuing treatment. This includes non-pharmacological strategies. Psychoeducation is also required to help pregnant women suffering from ADHD be aware of the symptoms and the underlying disorder. They should also learn about treatment options and build coping mechanisms. This should include an approach that is multidisciplinary, including the GP doctors, obstetricians and psychiatrists. The pregnancy counselling should consist of discussion of a management plan for both the mother and child, and monitoring for signs of deterioration and the need for adjustments to the medication regimen.