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ADHD Medication During Pregnancy and Breastfeeding

The decision to stop or keep ADHD medications during pregnancy and nursing is challenging for women with the condition. There isn't much information on how adhd medication works long-term exposure to these drugs could affect the foetus.

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

Risk/Benefit Analysis

Pregnant women who use ADHD medications need to balance the advantages of taking them against the potential risks to the foetus. Physicians don't have the data to give clear advice but they can provide information on risks and benefits to help pregnant women make informed decisions.

A study published in Molecular Psychiatry concluded that women who took strattera adhd medication medication during their early pregnancy were not at higher risk of fetal malformations or structural birth defects. The researchers used a large population-based case-control study to assess the risk of major structural birth defects in babies born to mothers who had taken stimulants during early pregnancy, and those who did not. Pediatric cardiologists and clinical geneticists looked over the cases to ensure an accurate classification of the cases and to reduce the chance of bias.

The study of the researchers had some limitations. In particular, they were unable to distinguish the effects of the medication from the effects of the underlying disorder. This makes it difficult to determine whether the small associations observed in the exposed groups are due to medication use or confounding by comorbidities. In addition the study did not examine the long-term effects of offspring on their parents.

The study did reveal that infants whose mothers took adhd medication Pregnancy medications during pregnancy were at a slightly higher risk of being admitted to the neonatal intensive care unit (NICU) than infants who were born without any best medication for inattentive adhd or taken off their medication prior to or during pregnancy. The reason for this was central nervous system-related disorders and the increased risk for admission was not found to be affected by the type of stimulant medications were used during pregnancy.

Women who took stimulant ADHD medications during pregnancy also had a higher likelihood of having an emergency caesarean section or having a baby that scored low on the Apgar scale (less than 7). These increases did not appear to be affected by the type of medication that was used during pregnancy.

Researchers suggest that the minor risk of using ADHD medications during early pregnancies can be offset by greater benefits to both mother and baby of continuing treatment for the woman's disorder. Physicians should discuss the issue with their patients and, when possible, assist them in developing strategies to improve coping skills that can lessen the impact 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 issue of whether to keep or end treatment during pregnancy is one that doctors are having to face. The majority of these decisions are made without any evidence that is clear and definitive in either case, which means that doctors have to weigh their experience, the experiences of other doctors, and what research suggests on the subject, along with their own judgments for each patient.

In particular, the issue of possible risks to the infant can be difficult. Many of the studies on this topic are based on observational evidence instead of controlled research and their findings are often contradictory. Most studies restrict their analysis to live-births, which could underestimate the severity of teratogenic effects leading to abortions or terminations of pregnancy. The study presented in this journal club addresses these shortcomings by analyzing data on live and deceased births.

Conclusion Some studies have found a positive correlation between ADHD medications and certain birth defects, other studies have not found a correlation. The majority of studies show that there is a neutral, or slight negative effect. Therefore, a careful risk/benefit analysis must be done in each instance.

It can be challenging, if not impossible for women with ADHD to stop taking their medication. In a recent article published in the Archives of Women's Mental Health by psychologist Jennifer Russell, she notes that stopping ADHD medications during pregnancy can lead to depression and feelings of being isolated. The loss of medication can also affect the ability to safely drive and perform work-related tasks, which are crucial aspects of daily life for those suffering from ADHD.

She suggests that women who are not sure whether to take the medication or stop due to pregnancy should educate family members, coworkers and acquaintances about the condition, the effects on daily functioning, and the advantages of staying on the current treatment plan. Educating them can also help the woman feel supported when she is struggling with her decision. It is also worth noting that some drugs can pass through the placenta, so if the patient decides to discontinue her ADHD medication during pregnancy and breastfeeding, she must be aware that the effects of the medication could be transferred to the child.

Birth Defects and Risk of

As the use and misuse of ADHD medications to treat the symptoms of attention deficit disorder hyperactivity disorder (ADHD) is increasing the concern over the possible effects of the drugs on the fetuses. A recent study published in the journal Molecular Psychiatry adds to the existing information on this topic. Researchers utilized two massive datasets to analyze more than 4.3 million pregnant women and determine whether stimulant medications increased the risk of birth defects. While the overall risk is low, the researchers found that exposure in the first trimester to ADHD medicines was associated with an increased risk of certain heart defects like ventriculo-septal defects (VSD).

The researchers of the study did not discover any link between early medication usage and congenital anomalies such as facial deformities or club feet. The results are consistent with previous studies revealing the presence of a small, but significant increase in the risk of cardiac malformations among women who began taking ADHD medications before the time of pregnancy. The risk was higher in the later part of pregnancy, when many women decide to stop taking their medication.

Women who took ADHD medication during the first trimester were more likely to require a caesarean delivery, have a low Apgar after delivery, and have a baby that needed breathing assistance after birth. However, the authors of the study were not able to eliminate bias due to selection by limiting the study to women who didn't have other medical issues that could have contributed to the findings.

Researchers hope their research will inform physicians when they meet pregnant women. The researchers recommend that while discussing the risks and benefits are important, the choice regarding whether or not to stop taking medication should be according to the severity of each woman's ADHD symptoms and her requirements.

The authors warn that, while stopping the medication is an option to think about, it isn't advised due to the high prevalence of depression and mental health issues in women who are expecting or have recently given birth. Further, research shows that women who stop taking their medication will have a tough transitioning to life without them after the baby is born.

Nursing

The responsibilities that come with being a new mom can be overwhelming. Women suffering from ADHD may face a lot of challenges when they have to manage their symptoms, go to doctor appointments and prepare for the birth of a baby and adjust to a new routine. This is why many women choose to continue taking their ADHD medication throughout the pregnancy.

The risk to a breastfeeding infant is minimal because the majority of stimulant medications is absorbed through breast milk in low amounts. The amount of exposure to medications can vary depending upon the dosage, frequency of administration and time of day. In addition, various medications are introduced into the baby's system through the gastrointestinal tract, or through breast milk. The effect 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 lack of research. This is a difficult choice for the patient, who must balance the benefits of keeping her medication against the possible dangers to the foetus. Until more information is available, GPs should ask all pregnant patients about their history of ADHD and if they plan or are taking to take medication during the perinatal period.

Many studies have shown that women can continue taking their ADHD medication in a safe manner during pregnancy and breast-feeding. In response, a growing number of patients are opting to continue their medication. They have found, in consultation with their doctor that the benefits of continuing their current medication outweigh risk.

Women who suffer from ADHD who plan to breastfeed should seek the advice of a specialist psychiatrist before becoming pregnant. They should discuss their medication with their doctor and discuss the pros and cons of continued treatment, including non-pharmacological strategies. Psychoeducation is also required to help pregnant women with ADHD be aware of the symptoms and underlying disorder. They should also learn about treatment options and strengthen coping mechanisms. This should be a multidisciplinary approach together with obstetricians, GPs and psychiatry. The pregnancy counselling should consist of discussion of a management plan for both the mother as well as the child, monitoring for signs of deterioration and when necessary, making adjustments to the medication regimen.