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ADHD Medication During Pregnancy and Breastfeeding

Women with ADHD face a difficult decision on whether to keep or stop taking ADHD medication during pregnancy and breast-feeding. There is a lack of information about how long-term exposure to these drugs could affect the fetus.

A study recently published in Molecular Psychiatry demonstrates that children exposed to ADHD medication during pregnancy do not develop neurological issues such as hearing loss or vision, febrile seizures or IQ impairment. The authors acknowledge that more high quality research is needed.

Risk/Benefit Analysis

Women who are pregnant and taking ADHD medication should evaluate the benefits of using it versus the risks for the foetus. The doctors don't have the information to give clear advice however they can provide information on risks and benefits to assist pregnant women to make an informed decision.

A study published in Molecular Psychiatry concluded that women who were taking ADHD medication in early pregnancy were not at higher risk of fetal malformations or structural birth defects. The researchers used a large population-based study of case-control to evaluate the incidence of major structural birth defects in infants born to mothers who had taken stimulants in early pregnancy and those who had not. Pediatric cardiologists, clinical geneticists and other experts examined the cases to confirm that the classification was accurate and to reduce any bias.

However, the researchers' study was not without its flaws. The researchers were not able in the beginning, to separate the effects of the medication for autism and adhd from the disorder. This makes it difficult for researchers to determine whether the small associations observed among the groups that were exposed to medication use, or if they were affected by co-morbidities. 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 slightly more risk of being admitted to the neonatal intensive care unit (NICU) than infants who whose mothers did not take any medication or taken off their medication prior to or during pregnancy. This increase was caused by central nervous system disorders. The increased risk of admission was not influenced by the stimulant medications used during pregnancy.

Women who were taking stimulant ADHD medications during pregnancy also had a higher risk of having a caesarean section or [Redirect Only] one whose baby scored low on the Apgar scale (less than 7). These increases didn't appear to be influenced by the kind of medication used during pregnancy.

Researchers suggest that the minor risks associated with the use ADHD medication during pregnancies in the early stages may be offset by the more beneficial outcomes for both baby and mother of continued treatment for the woman’s disorder. Physicians should discuss the issue with their patients and, when possible, assist them in developing strategies to improve their coping abilities that may minimize the negative impact of her condition 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 any evidence that is clear and definitive regardless, so doctors must weigh their knowledge from their own experiences, those of other doctors, and what the research says on the topic as well as their own judgments for each individual patient.

Particularly, the issue of potential risks to the baby can be a challenge. The research on this issue is based on observation instead of controlled studies and a lot of the results are conflicting. The majority of studies restrict their analysis to live births, which can underestimate the severity of teratogenic effects that can lead to terminations or abortions of pregnancy. The study that is discussed in the journal club addresses these issues, by examining both data on live and deceased births.

The conclusion: While certain studies have demonstrated that there is a positive correlation between ADHD medications and the possibility of certain birth defects, others have found no such relationship, and most effective adhd medication for adults studies show a neutral or even slight negative effect. In all cases it is imperative to conduct a thorough study of the potential risks and benefits must be performed.

It can be challenging, if not impossible, for women suffering from ADHD to stop taking their medication. In a recent article 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 isolation. In addition, a decrease in medication can interfere with the ability to do jobs and drive safely that are crucial aspects of daily life for many people with ADHD.

She recommends women who are uncertain 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 impact on daily life, and the benefits of keeping the current treatment plan. In addition, educating them can aid in ensuring that the woman feels supported in her struggle with her decision. Certain medications can be passed through the placenta. If a woman decides not to take her ADHD medication while breastfeeding, it's important to be aware that the drug could be passed on to her baby.

Risk of Birth Defects

As the use of ADHD drugs to treat symptoms of attention deficit hyperactivity disorder (ADHD) grows as do concerns about what impact the drugs could have on the fetuses. Recent research published in the journal Molecular Psychiatry has added to the body of knowledge on this issue. Using two massive data sets, researchers were able to look at more than 4.3 million pregnancies to determine whether the use of stimulant medications increased the risk of birth defects. While the overall risk is low, the researchers discovered that the first-trimester exposure to ADHD medications was linked to an increased risk of certain heart defects, such as ventriculo-septal defect (VSD).

The authors of the study didn't find any association between the use types of adhd medication early medications and congenital anomalies such as facial deformities or club feet. The results are in line with previous studies that showed a small, but significant increase in the number of cardiac malformations among women who began taking ADHD medication prior to pregnancy. The risk increased in the latter stages of pregnancy when many women decided to stop taking their medication.

Women who took ADHD medications in the first trimester of their pregnancy were also more likely to experience a caesarean section, a low Apgar score following delivery, and a baby that required breathing assistance at birth. The authors of the study could not remove bias in selection since they limited their study to women without other medical conditions that could have contributed to the findings.

Researchers hope that their study will inform physicians when they meet pregnant women. The researchers recommend that while discussing the risks and benefits are crucial, the decision regarding whether or not to stop medication should be made based on the severity of each woman's ADHD symptoms and the needs of the woman.

The authors caution that, although stopping the medication is an option to think about, it isn't advised due to the high rate depression and mental health issues among women who are pregnant or who have recently given birth. Research has also shown that women who stop taking their medication will have a tough time adjusting to a life without them after the baby is born.

Nursing

The responsibilities that come with being a new mom can be overwhelming. Women who suffer from ADHD can face severe challenges when they must deal with their symptoms, attend doctor appointments, prepare for the birth of their child and adjust to new routines. This is why many women decide to continue taking their adhd Focus Medication medications throughout the course of pregnancy.

The majority of stimulant medicines are absorbed through breast milk in very small amounts, so the risk to the nursing infant is very low. The rate of exposure to medication will vary based on the dosage, frequency of administration and the time of the day. In addition, various medications are introduced into the baby's system through the gastrointestinal tract, or through breast milk. The impact of these medications on the health of a newborn isn't completely understood.

Due to the absence of research, some physicians may recommend stopping stimulant medication during the course of pregnancy. This is a complicated decision for the patient, who must weigh the benefits of keeping her medication against the possible dangers to the fetus. As long as more information is available, GPs may ask pregnant patients whether they have any history of ADHD or if they plan to take medication in the perinatal phase.

Many studies have shown that women can continue taking their ADHD medication safely during pregnancy and while breast-feeding. In response, an increasing number of patients are choosing to do this. They have found after consulting with their physicians that the benefits of keeping their current medication outweigh any risk.

Women with ADHD who plan to breastfeed should seek the advice of an expert psychiatrist prior to becoming pregnant. They should review their medications with their doctor and discuss the advantages and disadvantages of continuing treatment, including non-pharmacological management strategies. Psychoeducation should also be offered to help pregnant women suffering from ADHD be aware of their symptoms and the root cause, learn about available treatment options and strengthen existing coping strategies. This should include a multidisciplinary approach, which includes the GP as well as obstetricians, psychiatry and obstetricians. Pregnancy counselling should include the discussion of a treatment plan for both mother and child, as well as monitoring for signs of deterioration and when necessary, making adjustments to the medication regimen.