ADHD Medication During Pregnancy and Breastfeeding The decision to stop or keep ADHD medications during breastfeeding and pregnancy is a challenge 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 problems such as hearing loss or vision, febrile seizures, or IQ impairment. The authors acknowledge the need for higher-quality studies. Risk/Benefit Analysis Women who are pregnant and take ADHD medication need to consider the benefits of taking it against the possible risks to the fetus. Physicians don't have the data to give clear advice, but 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 took ADHD medications in early pregnancy did not have an increased risk of fetal cardiac malformations or major birth defects that are structural. Researchers conducted a large population-based case control study to assess the frequency 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 make sure that the classification was accurate and to minimize any bias. However, the study was not without its flaws. The most important issue was that they were not able to differentiate the effects of the medication from the effects of the disorder that is underlying. This limitation makes it difficult for researchers to establish whether the small associations observed among the groups that were exposed to the use of medications or if they were affected by co-morbidities. In addition the study did not examine the long-term effects of offspring on their parents. The study did show that infants whose mothers had taken ADHD medication during pregnancy were at a more risk of being admitted to the neonatal intensive care unit (NICU) than those who were born without any medication or taken off their medication prior to or during pregnancy. This was due to central nervous system disorders, and the increased risk for admission did not appear to be influenced by which stimulant medications were used during pregnancy. Women who were taking stimulant ADHD medication during pregnancy were also at an elevated chance of having a caesarean section or having a child with a low Apgar score (less than 7). These increases appeared to be unrelated to the type of medication used during pregnancy. The researchers suggest that the risk of a small amount with the use of ADHD medications during early pregnancy may be offset by the higher benefit for both mother and child of continuing treatment for the woman's disorder. adhd medication list should discuss the issue with their patients and, when possible, help them develop strategies to improve their coping abilities that may minimize the effects of her disorder on her daily functioning and relationships. Medication Interactions As more women than ever are diagnosed with ADHD and being treated with medication, the dilemma of whether to continue or stop treatment during pregnancy is a question that more and more physicians have to face. Often, these decisions are taken in the absence of solid and reliable evidence regardless, so doctors must weigh what they know, the experiences of other doctors, and what the research suggests about the subject as well as their own judgments for each individual patient. The issue of potential risks for infants can be difficult to determine. Many of the studies on this issue are based on observational data rather than controlled research and their conclusions are often contradictory. The majority of studies focus on live births, which may underestimate the teratogenic impact which can cause terminations or abortions of pregnancy. The study presented in the journal club addresses these issues by analyzing both the data from deceased and live births. Conclusion Some studies have found a positive correlation between ADHD medications and certain birth defects, other studies have not established a link. Most studies have shown a neutral, or even slightly negative, impact. In the end an accurate risk-benefit analysis must be conducted in every situation. It isn't easy, but not impossible for women suffering from ADHD to stop taking their medication. In fact, in an article recently 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 also impact the ability to safely drive and complete work-related tasks, which are crucial aspects of daily life for those with ADHD. She suggests that women who are unsure whether to take the medication or stop due to pregnancy, educate their family members, colleagues, and acquaintances about the condition, its impact on daily functioning and the benefits of keeping the current treatment regimen. It will also help a woman feel supported in her decision. It is important to remember that some medications can pass through the placenta so if the patient decides to stop taking her ADHD medication during pregnancy and breastfeeding, she should be aware of the possibility that traces of the medication could be passed on to the baby. Birth Defects Risk As the use and misuse of ADHD drugs to treat symptoms of attention deficit hyperactivity disorder (ADHD) is increasing, so does concern about the possible effects of the drugs on the fetuses. A study that was published in the journal Molecular Psychiatry adds to the body of knowledge about this subject. Researchers used two huge data sets to examine over 4.3 million pregnant women and determine whether stimulant medications caused birth defects. Researchers discovered that, while the risk overall is low, first-trimester ADHD medication use was associated with slightly higher rates of specific heart defects like ventriculoseptal defects. The researchers of the study found no association between early use of medication and other congenital anomalies, like facial clefting, or club foot. The results are in line with previous studies that have shown a small but significant increase in the risk of heart malformations among women who started taking ADHD medications prior to the time of pregnancy. The risk was higher in the latter half of pregnancy, when many women are forced to stop taking their ADHD medications. Women who took ADHD medication in the first trimester of their pregnancies were also more likely to undergo caesarean section, low Apgar score following delivery, and a baby that required breathing assistance during birth. However the researchers of the study were unable to eliminate bias due to selection by limiting the study to women who didn't have any other medical conditions that could have contributed to these findings. Researchers hope that their study will provide doctors with information when they see pregnant women. The researchers suggest that, while discussing risks and benefits are important, the decision on 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 warn that, even though stopping the medication is a possibility to look into, it is not recommended due to the high prevalence of depression and other mental disorders for women who are pregnant or who have recently given birth. Research has also shown that women who stop taking their medication will have a difficult time adjusting to a life without them after the baby is born. Nursing It can be a challenge to become a mother. Women who suffer from ADHD who have to manage their symptoms while attending doctor appointments as well as getting ready for the arrival of a baby and getting used to new routines at home are often faced with a number of difficulties. Many women opt to continue taking their ADHD medication during pregnancy. The majority of stimulant drugs are absorbed by breast milk in small quantities, so the risk for breastfeeding infant is minimal. The rate of exposure to medication will vary based on the dosage, frequency of administration and time of day. In addition, different medications are introduced into the baby's system via the gastrointestinal tract or through breast milk. The effect on a newborn's health is not fully known. Some doctors may decide to stop stimulant medications during a woman's pregnancy due to the absence of research. This is a difficult decision for the woman who must weigh the advantages of her medication against the risks to the fetus. In the meantime, until more information is available, doctors should ask all pregnant patients about their history of ADHD and whether they plan or are taking to take medication during the perinatal period. Numerous studies have proven that women can continue to take their ADHD medication without risk during pregnancy and while breast-feeding. As a result, more and more patients are choosing to do so and, in consultation with their doctor they have discovered that the benefits of keeping their current medication far outweigh any risks. Women who suffer from ADHD who plan to breastfeed should seek advice from a specialist psychiatrist prior to becoming pregnant. They should discuss their medication with their prescriber, and the pros and cons of continuing treatment. This includes non-pharmacological strategies. Psychoeducation is also required to help pregnant women with ADHD recognize the signs and the underlying disorder. They should also learn about treatment options and build coping mechanisms. This should be 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 plan for management for both the mother as well as the child, and monitoring for signs of deterioration and the need for adjustments to the medication regimen.
adhd medication list
