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ADHD Medication During Pregnancy and Breastfeeding Women with ADHD have to make a difficult choice regarding whether or not to stop taking ADHD medication during pregnancy and breast-feeding. There isn't much information on how long-term exposure to these medications can affect the fetus. A study recently published in Molecular Psychiatry shows that children exposed to ADHD medication in the uterus do not develop neurological developmental conditions like hearing loss or impaired vision seizures, febrile seizures, or IQ impairment. The authors acknowledge that more high quality studies are needed. Risk/Benefit Analysis Women who are pregnant and taking ADHD medication should weigh the benefits of taking it against the potential risks for the fetus. The doctors don't have the information to provide clear recommendations, but can provide information on risks and benefits to help pregnant women make an informed decision. A study published in Molecular Psychiatry found that women who were taking ADHD medications during their early pregnancy did not have a significantly increased risk of fetal cardiac malformations or major structural birth defects. Researchers used a vast population-based case-control study to assess the risk of major structural birth defects in infants born to mothers who had taken stimulants in early 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 accurate and to reduce any bias. However, the study was not without its flaws. The researchers were not able in the beginning to differentiate the effects triggered by the medication from the disorder. This makes it difficult to determine whether the small associations observed in the groups that were exposed are due to the use of medication or comorbidities that cause confusion. Additionally adhd medications uk did not study the long-term outcomes of offspring. The study did show that babies 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 who were born without any medication or stopped their medications before or during pregnancy. This was due to central nervous system disorders. The increased risk of admission was not influenced by the stimulant medication that was used during pregnancy. Women who took stimulant ADHD medications during pregnancy also had a higher risk of having to have a caesarean section or a baby that scored low on the Apgar scale (less than 7). adult add medications did appear to be independent of the type of medication used during pregnancy. Researchers suggest that the small risk of using ADHD medications during early pregnancies could be offset by the more beneficial outcomes for both baby and mother of continued treatment for the woman's condition. Physicians should discuss this with their patients and, where they are able, assist them in developing strategies to improve coping skills that may minimize the effects of her disorder on her daily life and relationships. Interactions with Medication Doctors are increasingly confronted with the dilemma of whether to continue treatment or stop it during pregnancy as more women are diagnosed with ADHD. The majority of these decisions are made in the absence of clear and authoritative evidence either way, so physicians must weigh their knowledge, the experiences of other doctors, and what the research suggests on the subject as well as their own best judgment for each individual patient. Particularly, the subject of possible risks to the infant can be difficult. A lot of studies on this subject are based on observational data rather than controlled research, and their findings are often contradictory. Most studies limit their analysis to live births, which can underestimate the teratogenic impact which can cause abortions or terminations of pregnancy. The study presented in the journal club addresses these shortcomings, by examining both information on deceased and live births. Conclusion Some studies have shown an association between ADHD medications and certain birth defects, other studies have not shown such a relationship. The majority of studies show an unintended, or slightly negative, effect. In every case an in-depth analysis of the risks and benefits must be performed. For many women with ADHD, the decision to discontinue medication is difficult if not impossible. In fact, in a recent article in the Archives of Women's Mental Health, psychologist Jennifer Russell notes that stopping ADHD medication during pregnancy can cause depression, feelings of loneliness, and family conflict for patients with ADHD. The loss of medication can also affect the ability to drive safely and to perform work-related tasks which are vital aspects of normal life for people with ADHD. She recommends that women who are unsure about whether or not to stop taking medication because of their pregnancy consider the possibility of educating friends, family members and colleagues on the condition, its impact on daily life, and the advantages of continuing the current treatment plan. In addition, educating them can help the woman feel supported in her struggle with her decision. It is also worth noting that certain medications are able to pass through the placenta so if a woman decides to stop taking her ADHD medication during pregnancy and breastfeeding, she should be aware that the effects of the drug could be transferred to the infant. Birth Defects Risk As the use and use of ADHD medication to treat symptoms of attention deficit hyperactivity disorder (ADHD) increases, so does concern about the potential effects of these drugs on foetuses. Recent research published in the journal Molecular Psychiatry has added to the body of knowledge on this subject. Using two massive data sets researchers were able to examine more than 4.3 million pregnancies to determine whether the use of stimulant medications increased the risk of birth defects. Researchers found that while the risk overall is low, the first trimester ADHD exposure to medication was associated with slightly higher risk of specific heart defects such as ventriculoseptal defect. The authors of the study could not discover any link between the use of early medications and other congenital anomalies, like facial deformities or club feet. The results are in line with previous studies revealing an increase, but not significant, in the risk of developing cardiac malformations among women who started taking ADHD medications prior to the time of pregnancy. This risk increased in the later part of pregnancy, as many women begin to discontinue their ADHD medications. Women who took ADHD medication during the first trimester were more likely to require a caesarean birth or have a low Apgar after birth and have a baby who needed breathing assistance when they were born. However, the authors of the study were unable to eliminate selection bias by restricting the study to women who did not have any other medical conditions that could be a contributing factor to these findings. Researchers hope their research will provide doctors with information when they meet pregnant women. They advise that while the discussion of the benefits and risks is important, the decision to stop or maintain medication must be based on each woman's requirements and the severity of her ADHD symptoms. The authors caution that, while stopping the medication is a possibility to consider, it is not recommended due to the high rate depression and mental health issues for women who are pregnant or have recently given birth. Research has also shown that women who stop taking their medications will have a tough adjustment to life without them once the baby is born. Nursing The responsibilities of being a new mother can be overwhelming. Women who suffer from ADHD who must work through their symptoms while attending physician appointments as well as making preparations for the arrival of a baby and getting used to new routines at home may face a lot of challenges. Many women opt to continue taking their ADHD medication during pregnancy. The risk to a breastfeeding infant is minimal because the majority of stimulant medications is absorbed through breast milk at a low level. However, the frequency of exposure to medication by the infant can differ based on dosage, frequency it is administered and the time of the day the medication is administered. Additionally, different drugs enter the infant's system via the gastrointestinal tract or breast milk. The impact of these medications on the health of a newborn isn't completely known. Some physicians may discontinue stimulant medication during a woman’s pregnancy due to the absence of research. This is a difficult decision for the mother, who must weigh the benefits of her medication against the risk to the foetus. Until more information becomes available, doctors may ask pregnant patients whether they have any background of ADHD or if they are planning to take medication in the perinatal stage. A increasing number of studies have shown that most women can safely continue their ADHD medication while they are pregnant and nursing. This has led to an increasing number of patients opt to do this and, in consultation with their physician, they have found that the benefits of keeping their current medication outweigh any risks. Women with ADHD who plan to breastfeed should seek advice from an expert psychiatrist prior to becoming pregnant. They should discuss their medication with their doctor and discuss the pros and cons for continuing treatment. This includes non-pharmacological strategies. Psychoeducation should also be offered to help pregnant women suffering from ADHD be aware of their symptoms and the underlying disorder Learn about the available treatment options and strengthen existing strategies for coping. This should include a multidisciplinary approach with the GP as well as obstetricians, psychiatry and obstetricians. Pregnancy counseling should include discussion of a treatment plan for the mother and the child, as well as monitoring for signs of deterioration and, if needed adjustments to the medication regimen.