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ADHD Medication During Pregnancy and Breastfeeding

Women suffering from ADHD face a difficult decision on whether to keep or stop taking ADHD medication during pregnancy and breastfeeding. There are few data on how long-term exposure may affect a foetus.

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

Risk/Benefit Analysis

Women who are pregnant and taking ADHD medications must weigh the benefits of taking them against the potential risks to the foetus. Doctors don't have enough data to make unambiguous recommendations however they can provide information about risks and benefits to assist pregnant women to make an informed decision.

A study published in Molecular Psychiatry found that women who took ADHD medications during their early pregnancy did not have a significantly increased risk of fetal cardiac malformations or major birth defects that are structural. Researchers used a large population-based study of case control to compare the incidence of structural defects that were major in infants who were born to mothers who used stimulants during pregnancy. Pediatric cardiologists, clinical geneticists and other experts examined the cases to confirm 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 separate the effects of the medication from the disorder. That 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. Researchers also did not examine long-term outcomes for the offspring.

The study did show that infants whose mothers had taken ADHD medication during pregnancy were at a slightly higher risk of being admitted to the neonatal intensive care unit (NICU) than those who were born without any medication or had stopped their medications before or during pregnancy. This was due to central nervous system disorders. The higher 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 chance of having to have a caesarean section or one whose baby scored low on the Apgar scale (less than 7). These risks did not seem to be influenced by the kind of medication used during pregnancy.

The research suggests that the low risk associated with the use of ADHD medications during the early stages of pregnancy could be offset by the greater benefit for both mother and child from continued treatment for the woman's disorder. Physicians should discuss the issue with their patients and, when possible, help them develop strategies to improve their coping abilities that may minimize the impact of her disorder on her daily functioning and relationships.

Medication Interactions

As more women than ever are diagnosed with ADHD and treated with medication, the issue of whether or not to stop treatment during pregnancy is one that more and more physicians confront. These decisions are often made without clear and authoritative evidence. Instead, doctors must weigh their own knowledge, the experience of other doctors and the research on the topic.

The issue of possible risks to infants is difficult to determine. The research on this issue is based on observations instead of controlled studies and a lot of the results are in conflict. Furthermore, most studies restrict their analysis to live births, which may underestimate severe teratogenic effects that cause abortion or termination of the pregnancy. The study discussed in the journal club addresses these limitations, by examining both the data from deceased and live births.

Conclusion Some studies have found an association between ADHD medications and certain birth defects, other studies have not found a correlation. Most studies have shown an unintended, or slightly negative, impact. In each case an in-depth study of the potential risks and benefits should be conducted.

For many women with ADHD, the decision to discontinue medication is difficult, if not impossible. In an article published in Archives of Women's Mental Health psychologist Jennifer Russell notes that stopping ADHD medication during pregnancy can cause depression, feelings of isolation and family conflict for these patients. A loss of medication may 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 women who are unsure about whether to keep or stop taking medication because of their pregnancy, consider informing family members, friends and colleagues on the condition, its impact on daily life, and the advantages of staying on the current treatment regimen. Educating them can also help the woman feel supported as she struggles with her decision. It is important to remember that certain medications can pass through the placenta, therefore, if a patient decides to discontinue her ADHD medication during pregnancy and breastfeeding, she should be aware that traces of the drug can be transferred to the child.

Risk of Birth Defects

As the use of ADHD medication to treat the symptoms of attention deficit hyperactivity disorder (ADHD) grows, so do concerns over the counter adhd medication the impact that these drugs could have on fetuses. Recent research published in the journal Molecular Psychiatry has added to the body knowledge on this subject. With two massive data sets researchers were able analyze more than 4.3 million pregnancies and see whether stimulant medications increased the risk of birth defects. Researchers discovered that, while the risk overall is low, first-trimester ADHD exposure to medication was associated with slightly higher risk of specific heart defects such as ventriculoseptal defect.

The researchers behind the study found no link between early use of medication and other congenital abnormalities, such as facial clefting or club foot. The findings are in line with previous studies revealing the presence of 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. This risk increased during the latter stages of pregnancy when many women began to stop taking their medication.

Women who were taking ADHD medication during the first trimester were more likely require a caesarean birth or have an insufficient Apgar after delivery, and have a baby that needed breathing assistance when they were born. However the researchers of the study were not able to eliminate bias due to selection by limiting the study to women who did not have any other medical conditions that could have contributed to the findings.

Researchers hope that their research will provide doctors with information when they encounter pregnant women. The researchers advise that, while discussing the risks and benefits are important, the choice about whether to continue or stop taking medication should be according to the severity of each woman's ADHD symptoms and the needs of the woman.

The authors warn that, although stopping the medication is an option to look into, it is not recommended because of the high incidence of depression and other mental disorders for women who are pregnant or who have recently given birth. Additionally, the research suggests that women who decide to stop their medications are more likely to have a difficult time adjusting to life without them after the birth of their baby.

Nursing

The responsibilities that come with being a new mom can be overwhelming. Women with ADHD who must work through their symptoms while attending doctor appointments, preparing for the arrival of a child and getting used to new routines at home can experience severe challenges. Many women choose to continue taking their ADHD medication during pregnancy.

The majority of stimulant drugs pass through breast milk in very small amounts, so the risk to infant who is breastfeeding is low. The rate of exposure to medication will differ based on dosage the medication is administered, its frequency 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 known.

Some doctors may decide to stop stimulant medication during a woman’s pregnancy due to the lack of research. This is a complicated decision for the patient, who must balance the benefits of keeping her medication against the possible dangers to the fetus. Until more information is available, GPs should ask all pregnant patients about their experience with ADHD and if they plan or are taking to take medication during the perinatal time.

A growing number of studies have proven that the majority of women are able to safely continue their ADHD medication during pregnancy and while breastfeeding. In response, a rising number of patients are opting to do this. They have discovered after consulting with their physicians, that the benefits of keeping their current medication outweigh any risk.

It's important for women with adhd Focus medication who are considering breastfeeding to seek out a specialist psychiatrist's advice prior becoming pregnant. They should discuss the medication they are taking with their physician, and the pros and cons of continuing treatment. This includes non prescription adhd medication for adults-pharmacological methods. Psychoeducation is also required to help pregnant women with inattentive adhd medication be aware of the symptoms and underlying disorder. They should also be educated about treatment options and build strategies for coping. This should include an approach that is multidisciplinary, including the GP as well as obstetricians, psychiatry and obstetricians. The pregnancy counselling should consist of the discussion of a treatment plan for both mother and child, and monitoring for signs of deterioration and the need for adjustments to the medication regimen.