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ADHD Medication During Pregnancy and Breastfeeding

The decision to stop or continue ADHD medications during breastfeeding and pregnancy is a difficult decision for women suffering from the condition. There are few data on how long-term exposure may affect a fetus.

A study recently published in Molecular Psychiatry demonstrates that children exposed to ADHD medication during pregnancy do not develop neurological issues such as impaired hearing or vision, febrile seizures or IQ impairment. The authors acknowledge the need for more high-quality studies.

Risk/Benefit Analysis

Women who are pregnant and taking ADHD medications must weigh the advantages of using them against the risks to the fetus. Physicians don't have the data to give clear advice however they can provide information on risks and benefits to aid pregnant women in making informed choices.

A study published in Molecular Psychiatry concluded that women who took ADHD medication in early pregnancy were not at a greater risk of fetal malformations, or structural birth defects. Researchers conducted a large population-based study of case-control to determine the prevalence of major structural birth defects in babies born to mothers who took stimulants during early pregnancy, as well as those who had not. Clinical geneticists, pediatric cardiologists and other experts looked over the cases to make sure that the classification was correct and to eliminate any bias.

The research conducted by the researchers had some limitations. The most important issue was that they were unable to distinguish the effects of the medication from the underlying disorder. This makes it difficult to determine whether the limited associations observed in the groups that were exposed result from medication use or confounding by comorbidities. In addition the study did not examine the long-term outcomes of offspring.

The study found that infants whose mother took common adhd Medications medication during pregnancy had a slightly higher risk of admission to the neonatal care unit (NICU) as compared to those whose mothers did not use any medication during pregnancy or had quit taking the 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 likelihood of having to have a caesarean section or the baby was not scoring well on the Apgar scale (less than 7). These increases appear to be unrelated to the type of medication used during pregnancy.

Researchers suggest that the small risks associated with the use ADHD medication during pregnancies in the early stages can be offset by greater benefits to both mother and baby from continuing treatment for the woman’s disorder. Physicians should discuss the issue with their patients and, when they are able, assist them in developing strategies to improve coping skills that can lessen the negative impact of her condition on her daily functioning and relationships.

Interactions with Medication

As more women than ever are diagnosed with ADHD and treated with medication, the dilemma of whether to continue or discontinue treatment during pregnancy is a question that more and more physicians confront. Most of the time, these decisions are taken in the absence of clear and authoritative evidence in either case, which means that doctors must weigh their knowledge from their own experiences, those of other doctors, and what the research suggests about the subject and their own best judgment for each individual patient.

In particular, the issue of potential risks for the baby can be a challenge. Many studies on this subject are based on observations rather than controlled research and their findings are often contradictory. In addition, most studies limit their analysis to live births, which adhd medication is the best could underestimate the severity of teratogenic effects that could result in abortion or termination of the pregnancy. The study presented in this journal club addresses these shortcomings by looking at data from both live and deceased births.

The conclusion is that while some studies have shown a positive association between ADHD medications and the risk of certain birth defects, other studies have found no connection and the majority of studies demonstrate a neutral or slightly negative effect. In every case it is imperative to conduct a thorough evaluation of the potential risks and benefits must be performed.

It can be challenging, if not impossible, for women with ADHD to stop taking their medication. In a recent piece published in 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 loneliness. In addition, a decrease in medication may affect the ability to do jobs and drive safely which are essential aspects of daily life for many people with ADHD.

She suggests that women who aren't sure whether to continue taking medication or stop due to pregnancy, educate their family members, coworkers, and acquaintances about the condition, its effects on daily functioning, and the advantages of staying on the current treatment plan. Educating them can also help the woman feel supported in her struggle with her decision. Some medications can pass through the placenta. If a patient decides to stop taking her ADHD medication while pregnant and breastfeeding, it's important to be aware that the medication could be passed on to her infant.

Birth Defects and Risk of

As the use of ADHD drugs to treat symptoms of attention deficit hyperactivity disorder (ADHD) grows, so do concerns about what impact the drugs might have on the fetuses. A study that was published in the journal Molecular Psychiatry adds to the body of knowledge on this subject. Using two massive data sets researchers were able look at more than 4.3 million pregnancies and see whether stimulant medications increased the risk of birth defects. While the overall risk remains low, the researchers found that exposure in the first trimester to ADHD medications was linked to an increased risk of certain heart defects like ventriculo-septal defects (VSD).

The researchers behind the study found no connection between the use of early medications and congenital abnormalities like facial clefting, or club foot. The results are in line with previous studies showing a small but significant increase in the risk of developing cardiac malformations among women who began taking ADHD medications prior to the birth of their child. The risk increased in the latter part of pregnancy when many women stopped taking their medication.

Women who took ADHD medication during the first trimester were more likely to require a caesarean delivery and also have an insufficient Apgar after birth and have a baby that needed breathing assistance after birth. However the researchers of the study were unable to eliminate selection bias by limiting the study to women who didn't have any other medical issues that could have contributed to these findings.

Researchers hope that their study will help doctors when they meet pregnant women. The researchers recommend that, while discussing the risks and benefits are important, the decision about whether to continue or stop taking medication should be based on the severity of each woman's ADHD symptoms and the needs of the woman.

The authors also caution that even though stopping the medication is an alternative, it is not an option to consider due to the high prevalence of depression and other mental health problems for women who are expecting or who are recently postpartum. Additionally, the research suggests that women who choose to stop their medications are more likely to have difficulties adapting to life without them following the birth of their baby.

Nursing

It can be overwhelming becoming a mother. Women with ADHD may face a lot of challenges when they must deal with their symptoms, attend doctor appointments, prepare for the birth of their child and adjust to a new routine. Therefore, many women choose to continue taking their ADHD medications throughout the course of pregnancy.

The majority of stimulant medications are absorbed by breast milk in small amounts, therefore the risk for breastfeeding infant is minimal. The rate of medication exposure can vary depending upon the dosage, frequency of administration and time of day. In addition, different medications enter the baby’s system via the gastrointestinal tract or breast milk. The impact on a newborn's health is not completely comprehended.

Due to the absence of evidence, some doctors might be tempted to stop taking stimulant drugs during a woman's pregnancy. This is a complicated decision for the patient, who must weigh the benefits of continuing her medication with the potential risks to the fetus. In the meantime, until more information is available, GPs should ask all adhd medications pregnant patients about their experience with adhd medication private prescription and whether they plan or are taking to take medication during the perinatal time.

A growing number of studies have revealed that the majority of women are able to safely continue their ADHD medication during pregnancy and while breastfeeding. This has led to many patients are choosing to do so, and in consultation with their doctor they have discovered that the benefits of continuing their current medication outweigh any potential risks.

Women who suffer from ADHD who are planning to breastfeed should seek advice from an expert psychiatrist prior to becoming pregnant. They should review their medications with their physician and discuss the pros and cons of continued treatment, including non-pharmacological strategies. Psychoeducation is also required to help pregnant women suffering from ADHD be aware of their symptoms and underlying disorder Learn about the available treatment options and reinforce existing strategies for coping. This should be a multidisciplinary process including obstetricians, GPs, and psychiatrists. 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.