ADHD Medication During Pregnancy and Breastfeeding The decision to stop or keep ADHD medications during pregnancy and nursing is a challenge for women suffering from the condition. There aren't many studies regarding how exposure over time may affect the foetus. A study recently published in Molecular Psychiatry shows that children exposed to ADHD medication during the uterus don't develop neurological disorders like impaired vision or hearing seizures, febrile seizures or IQ impairment. The authors acknowledge that more high-quality research is needed. Risk/Benefit Analysis Women who are expecting and taking ADHD medication should evaluate the benefits of using it against the possible dangers for the baby. Physicians don't have the data to make unambiguous recommendations but they can provide information on risks and benefits to aid pregnant women in making an informed decision. A study published in Molecular Psychiatry found that women who used ADHD medications during their early pregnancy did not have a significantly higher risk of fetal cardiac malformations or major birth defects that are structural. Researchers conducted a massive population-based case control study to examine the prevalence of major structural defects in infants who were born to mothers who took stimulants during pregnancy. Clinical geneticists, pediatric cardiologists and other experts examined the cases to confirm that the classification was correct and to eliminate any bias. However, the researchers' study had its limitations. Most important, they were not able to differentiate the effects of the medication from those of the underlying disorder. This makes it difficult to know whether the small differences observed in the exposed groups are due to medication use or the confounding effect of comorbidities. In addition the study did not study long-term offspring outcomes. The study showed that babies whose mothers took ADHD medication during pregnancy had a higher chance of being admitted to the neonatal care unit (NICU) in comparison to mothers who did not take any medication during pregnancy, or had quit taking the medication prior to or during pregnancy. This was due to central nervous system 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 used stimulant ADHD medication during pregnancy were also at an increased risk of having a caesarean section or having a baby born with an low Apgar score (less than 7). These risks did not appear to be affected by the type of medication that was used during pregnancy. Researchers suggest that the small risk of using ADHD medication during pregnancies in the early stages could be offset by the greater benefits for baby and mother of 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 which can reduce the effects of her disorder on her daily functioning and relationships. Medication Interactions Doctors are increasingly faced with the decision of whether to keep treatment or stop during pregnancy as more women are diagnosed with ADHD. These decisions are often taken without clear and authoritative evidence. Instead, doctors have to take into account their own experience in conjunction with the experiences of other doctors and the research on the topic. Particularly, the subject of potential risks for the baby can be tricky. The research on this subject is based on observation rather than controlled studies, and many of the findings are in conflict. Most studies focus on live births, which can underestimate the severity of teratogenic effects leading to terminations or abortions of pregnancy. The study presented in this journal club addresses these issues by examining data on both live and deceased births. The conclusion The conclusion: While certain studies have demonstrated an association between ADHD medications and the possibility of certain birth defects, others have found no such relationship, and most studies demonstrate a neutral or slightly negative impact. In all cases, a careful analysis of the benefits and risks is required. For many women with ADHD, the decision to discontinue medication is difficult, if not impossible. In an article recently published in the Archives of Women's Mental Health psychologist Jennifer Russell notes that stopping ADHD medication during pregnancy can lead to increased depression, feelings of loneliness, and family conflict for patients with ADHD. Additionally, the loss of medication may affect the ability to complete work-related tasks and safely drive that are crucial aspects of daily life for many people with ADHD. She recommends that women who are unsure about whether to keep or stop medication in light of their pregnancy should consider educating family members, friends and colleagues about the condition, its effects on daily functioning, and on the advantages of staying on the current treatment plan. It can also help women feel supported in 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 can be transferred to the infant. Birth Defects Risk As the use of ADHD drugs to treat symptoms of attention deficit hyperactivity disorder (ADHD) increases as do concerns about what impact the drugs might have on foetuses. A study that was published in the journal Molecular Psychiatry adds to the existing knowledge on this subject. Researchers used two huge data sets to study more than 4.3 million pregnant women and determine if stimulant medication use caused birth defects. Although the risk overall remains low, the scientists found that exposure in the first trimester to ADHD medications was linked to an increase in the risk of specific heart defects, such as ventriculoseptal defect (VSD). The authors of the study found no link between the use of early medications and congenital abnormalities such as facial clefting or club foot. The results are in agreement with previous studies that have shown the existence of a slight, but significant increase in cardiac malformations for women who started taking ADHD medication prior to the time of pregnancy. The risk was higher in the latter half of pregnancy, when a lot of women begin to discontinue their ADHD medications. Women who took ADHD medication in the first trimester of pregnancy were also more likely to have a caesarean section, a low Apgar score after delivery and a baby who required help breathing at birth. However the authors of the study were not able to eliminate bias due to selection by restricting the study to women who did not have other medical issues that could be a contributing factor to these findings. Researchers hope that their study will inform physicians when they meet pregnant women. The researchers advise that while discussing the risks and benefits are important, the decision on whether to continue or stop taking medication should be in light of the severity of each woman's ADHD symptoms and her needs. The authors also advise that, while stopping the medication is an alternative, it is not an option to consider due to the high rate of depression and other mental health problems in women who are pregnant or who are recently post-partum. Additionally, the research suggests that women who decide to stop their medications are more likely to experience a difficult time getting used to life without them after the birth of their baby. Nursing The responsibilities of a new mother can be overwhelming. Women with ADHD can face severe challenges when they have to manage their symptoms, go to doctor appointments and prepare for the birth of a child and adjust to a new routine. Many women opt to continue taking their ADHD medication during pregnancy. The majority of stimulant medications are absorbed through breast milk in low quantities, so the risk to breastfeeding infant is minimal. The rate of medication exposure will vary based on the dosage the medication is administered, its frequency and time of day. In addition, individual medications enter the body of the baby differently through the gastrointestinal tract and breast milk. The impact of this on a newborn is not yet fully understood. Some physicians may discontinue stimulant medication during a woman’s pregnancy due to the absence of research. how to treat adhd without medication in adults is a complicated decision for the patient, who must balance the benefits of continuing her medication against the possible risks to the fetus. As long as more information is available, doctors can ask pregnant patients if they have an history of ADHD or if they intend to take medication in the perinatal phase. Numerous studies have proven 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 so. They have discovered through consultation with their doctors, that the benefits of continuing their current medication outweigh potential risks. Women with ADHD who are planning to breastfeed should seek advice from a specialist psychiatrist before becoming pregnant. They should discuss their medication with their prescriber 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 understand their symptoms and underlying disorder, learn about available treatment options and reinforce existing strategies for coping. This should involve a multidisciplinary approach, which includes the GP as well as obstetricians, psychiatry and obstetricians. Pregnancy counseling should include discussion of a treatment plan for the mother as well as the child, and monitoring for signs of deterioration and, if necessary, adjustments to the medication regimen.
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