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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 aren't many studies on how long-term exposure may affect the pregnant fetus.

A recent study published in Molecular Psychiatry demonstrates that children exposed to adhd medication pregnancy medication during pregnancy do not develop neurological disorders such as hearing loss or vision, febrile seizures or IQ impairment. The authors acknowledge the need for higher-quality studies.

Risk/Benefit Analysis

Pregnant women who take ADHD medications need to balance the benefits of using them against the risks to the foetus. Physicians don't have the data to make unambiguous recommendations but they can provide information on risks and benefits to assist pregnant women to make an informed decision.

A study published in Molecular Psychiatry concluded that women who took ADHD medication during their early pregnancy were not at a higher risk of fetal malformations, or structural birth defects. Researchers conducted a large population-based case-control study to assess the risk of major structural birth defects in infants born to mothers who had taken stimulants in the early stages of pregnancy, and those who did not. Clinical geneticists, pediatric cardiologists and other experts looked over the cases to ensure that the classification was correct and to minimize any bias.

The study conducted by the researchers was not without its limitations. The researchers were unable to, in the first place to distinguish the effects caused by the medication from the disorder. This makes it difficult for researchers to establish whether the small associations observed among the exposed groups were due to the use of medications, or Adhd medication pregnancy if they were caused by co-morbidities. The researchers also did not examine long-term outcomes for offspring.

The study revealed that infants whose mothers took ADHD medication during pregnancy had a slightly higher risk of admission to the neonatal care unit (NICU) in comparison to mothers who didn't take any medication during pregnancy or had quit taking the medication prior to or during pregnancy. This was due to central nervous system-related disorders, and the higher risk of admission did not appear to be affected by the type of stimulant medications were used during pregnancy.

Women who were taking stimulant ADHD medications during pregnancy also had a higher chance of having to have an emergency caesarean section or having a baby that scored low on the Apgar scale (less than 7). These increases did appear to be unrelated to the type of medication used during pregnancy.

The researchers suggest that the low risk associated with the use of ADHD medications during early pregnancy could be offset by the greater benefits to both the mother and child of continuing treatment for the woman's condition. Physicians should talk to their patients about this and, if possible, help them improve coping skills which may reduce the impact of her disorder in her daily functioning and her relationships.

Medication Interactions

More and more doctors are confronted with the dilemma of whether to maintain treatment or stop as more women are diagnosed with ADHD. Often, these decisions are made in the absence of any evidence that is clear and definitive in either case, which means that doctors must weigh what medication is prescribed for adhd they know, the experiences of other doctors, and what medication is given for adhd research suggests about the subject as well as their best medicine for adhd and social anxiety judgment for each individual patient.

Particularly, the issue of possible risks to the baby can be tricky. A lot of studies on this subject are based on observational data rather than controlled research and their conclusions are often contradictory. Furthermore, most studies restrict their analysis to live births, which can underestimate severe teratogenic effects that lead to abortion or termination of the pregnancy. The study that is discussed in this journal club addresses these limitations by analyzing data on live and deceased births.

Conclusion A few studies have shown a positive correlation between ADHD medications and certain birth defects, other studies have not found a correlation. Most studies show an unintended, or slight negative impact. Therefore, a careful risk/benefit assessment must be done in each situation.

It can be difficult, if not impossible, for women suffering from ADHD to stop taking their medication. In fact, in an article 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 isolation and family conflict for those suffering from the disorder. A loss of medication may also impact the ability to drive safely and perform work-related tasks, which are crucial aspects of normal life for those suffering from ADHD.

She suggests that women who aren't sure whether to take the medication or discontinue it due to pregnancy educate family members, coworkers and their friends about the condition, its effects on daily functioning, adhd medication pregnancy and the benefits of keeping the current treatment. It will also help a woman feel confident about her decision. Some medications can pass through the placenta. If the patient decides to stop taking her ADHD medication while breastfeeding, it is crucial to be aware that the medication may be transferred to her baby.

Birth Defects Risk

As the use and misuse of ADHD medications to treat the symptoms of attention deficit disorder hyperactivity disorder (best adhd medication for adults with anxiety and depression), increases the concern over the possible effects of the drugs on fetuses. Recent research published in the journal Molecular Psychiatry has added to the body of knowledge regarding this topic. Researchers used two huge data sets to examine over 4.3 million pregnancies and determine if stimulant medication use caused birth defects. While the overall risk remains low, the scientists did find that first-trimester exposure to ADHD medications was linked to a slightly higher rate of specific heart defects, like ventriculo-septal defects (VSD).

The researchers of the study didn't find any association between early medication usage and other congenital anomalies like facial deformities or club feet. The results are consistent with previous studies revealing a small but significant increase in the risk of cardiac malformations among women who started taking ADHD medications prior to the time of pregnancy. The risk was higher in the latter half of pregnancy, as many women decide to stop taking their medication.

Women who used ADHD medication in the first trimester of their pregnancy were also more likely to undergo caesarean sections, a low Apgar score following delivery, and a baby who required breathing assistance at birth. The researchers of the study could not remove bias in selection since they limited their study to women without other medical conditions that could have contributed to the findings.

The researchers hope their research will help inform the clinical decisions of physicians who encounter pregnant women. The researchers recommend that, while discussing risks and benefits are important, the decision on whether to continue or stop medication should be based on the severity of each woman's ADHD symptoms and her requirements.

The authors also caution that even though stopping the medication is an alternative, it is not an option to consider due to the high incidence of depression and other mental health issues among women who are pregnant or postpartum. 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

It can be a stressful experience to become a mom. Women who suffer from ADHD can face severe challenges when they must manage their symptoms, attend doctor appointments and prepare for the birth of a baby bipolar and adhd medication adjust to new routines. As such, many women decide to continue taking their ADHD medications throughout pregnancy.

The risk for breastfeeding infant is minimal because the majority of stimulant medication is absorbed through breast milk at a low level. However, the frequency of medication exposure to the newborn may differ based on the dosage, frequency it is administered, and the time of day it is administered. In addition, different medications enter the baby’s system via the gastrointestinal tract or through breast milk. The impact on the health of a newborn is not completely comprehended.

Due to the absence of research, some physicians may recommend stopping stimulant medications during the pregnancy of a woman. This is a difficult decision for the patient, who must balance the benefit of continuing her medication against the potential dangers to the embryo. Until more information is available, doctors should inquire with all pregnant patients about their experience with ADHD and whether they plan or are taking to take medication during the perinatal time.

A growing number of studies have revealed that most women can safely continue to take their ADHD medication during pregnancy and while breastfeeding. In response, a growing number of patients are choosing to do so. They have discovered, in consultation with their doctors, that the benefits of continuing their current medication far outweigh any risk.

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 doctor and discuss the pros and cons of continuing treatment. This includes non-pharmacological strategies. Psychoeducation is also required to help women with ADHD understand their symptoms and the underlying disorder, learn about available treatments and to reinforce existing strategies for managing. This should include an approach that is multidisciplinary, including the GP as well as obstetricians, psychiatry and obstetricians. Pregnancy counseling should include a discussion of a treatment plan for the mother and the child, and monitoring for signs of deterioration and, if needed modifications to the medication regimen.