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ADHD Medication During Pregnancy and Breastfeeding

The decision to stop or continue ADHD medications during pregnancy and nursing is a challenge for women suffering from the condition. There are few data regarding how exposure over time may affect the foetus.

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 more high-quality research.

Risk/Benefit Analysis

Pregnant women who use ADHD medications must weigh the advantages of using them against the risks to the fetus. Doctors don't have enough data to give clear advice however they can provide information on the risks and benefits to help pregnant women make informed decisions.

A study published in Molecular Psychiatry found that women who used ADHD medications in 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 case control study to examine the prevalence of major structural defects in infants who were born to mothers who were taking stimulants during pregnancy. Pediatric cardiologists, clinical geneticists and other experts looked over the cases to make sure that the classification was accurate and to eliminate any bias.

The research conducted by the researchers was not without limitations. Most important, they were unable to distinguish the effects of the medication from the effects of the underlying disorder. That limitation makes it difficult to determine whether the small associations observed in the exposed groups result from medication use or comorbidities that cause confusion. Researchers also did not look at long-term outcomes for offspring.

The study revealed that infants whose mothers took ADHD medication during pregnancy were at a slightly higher risk of admission to the neonatal care unit (NICU), compared to those whose mothers did not take any medication during pregnancy or discontinued taking their medication prior to or during pregnancy. The reason for this was central nervous system disorders. The increased risk of admission was not affected by the stimulant medication that was used during pregnancy.

Women who took stimulant ADHD medication during pregnancy were also at an elevated risk of having a caesarean delivery or having a child with low Apgar score (less than 7). These increases appeared to be independent of the type of medication taken during pregnancy.

Researchers suggest that the small risks posed by the use of ADHD medications during early pregnancies can be offset by greater benefits to both mother and baby from continuing treatment for the woman's condition. Physicians should discuss this with their patients and, when possible, assist them in developing strategies for improving their coping skills that may minimize the impact of her disorder on her daily life and relationships.

Medication Interactions

As more women than ever before are being diagnosed with ADHD and being treated with medication, the issue of whether or not to discontinue treatment during pregnancy is one that more and more physicians face. These decisions are frequently taken without clear and authoritative evidence. Instead, physicians must weigh their own knowledge and experience, as well as the experiences of other doctors and the research that has been conducted on the subject.

The issue of risk to infants is particularly tricky. Many studies on this subject are based on observational data rather than controlled research, and their findings are often contradictory. Additionally, the majority of studies limit their analysis to live births, which could undervalue the serious teratogenic effects that can result in abortion or termination of the pregnancy. The study discussed in this journal club addresses these limitations by looking at data from both live and deceased births.

Conclusion: While some studies have shown an association between ADHD medications and certain birth defects however, other studies haven't found a correlation. Most studies show an unintended, or somewhat negative, impact. In each case an in-depth analysis of the risks and benefits must be performed.

It isn't easy, but not impossible, for women with ADHD to stop taking their medication. In a recent article in Archives of Women's Mental Health by psychologist Jennifer Russell, she notes that stopping ADHD medications during pregnancy can cause depression and feelings of loneliness. Additionally, the loss of medication can interfere with the ability to do work-related tasks and safely drive, which are important aspects of a normal life for a lot of people with ADHD.

She recommends women who are unsure about whether to continue or stop medication in light of their pregnancy, consider educating family members, friends, and coworkers on the condition, its effects on daily functioning, and the advantages of staying on the current treatment regimen. In addition, educating them can help the woman feel supported when she is struggling with her decision. It is important to remember that some medications can pass through the placenta, so if the patient decides to stop her ADHD medication during pregnancy and breastfeeding, she should be aware that traces of the medication could be transferred to the infant.

Birth Defects Risk

As the use and abuse of ADHD drugs to treat symptoms of attention deficit hyperactivity disorder (ADHD) increases as does the concern about the potential effects of these drugs on fetuses. A study that was published in the journal Molecular Psychiatry adds to the body of knowledge on this subject. Researchers used two massive data sets to study over 4.3 million pregnancies and determine whether stimulant medications increased birth defects. Researchers found that while the overall risk is low, the first trimester ADHD exposure to medication was associated with slightly higher risk of certain heart defects, like ventriculoseptal defect.

The researchers of the study could not discover any link between early medication usage and other congenital anomalies like facial deformities, or club feet. The results are in the same vein as previous studies which showed a small, but significant increase in cardiac malformations for women who started taking ADHD medication before the time of pregnancy. The risk increased in the latter stages of pregnancy when many women began to stop taking their medication.

Women who took adhd medication pregnancy (Kingranks.com) medication during the first trimester were more likely require a caesarean delivery, have a low Apgar after birth and have a baby that needed breathing assistance when they were born. However, the authors of the study were not able to eliminate selection bias by limiting the study to women who did not have other medical issues that could have contributed to these findings.

The researchers hope their research will serve to inform the clinical decisions of doctors who see pregnant women. The researchers recommend 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 caution that, while stopping the medication is a possibility to consider, it is not recommended because of the high incidence of depression and mental health issues in women who are expecting or who have recently given birth. Further, the research suggests that women who choose to stop taking their medications are more likely to have a difficult time adjusting to life without them following the birth of their baby.

Nursing

It can be overwhelming becoming a mother. Women who suffer from ADHD may face a lot of challenges when they must manage their symptoms, attend doctor appointments, prepare for the birth of a baby and adjust to new routines. Therefore, many women decide to continue taking their ADHD medications throughout pregnancy.

The risk to breastfeeding infant is not too high since the majority of stimulant medication passes through breast milk at low levels. However, the amount of medication exposure to the newborn may differ based on dosage, frequency it is administered and at what time it is administered. In addition, individual medications enter the infant's system differently through the gastrointestinal tract as well as breast milk and the impact of this on a newborn is not well known.

Some doctors may decide to stop stimulant medication during a woman's pregnancy due to the absence of research. This is a difficult decision for the patient, who must balance the benefit of continuing her medication against the potential dangers to the embryo. As long as more information is available, doctors may inquire about pregnant patients if they have an background of ADHD or if they plan to take medication during the perinatal phase.

A growing number of studies have shown that most women can safely continue their adhd medication private prescription medication during pregnancy and while breastfeeding. In response, a rising number of patients are choosing to do so. They have found after consulting with their doctor that the benefits of retaining their current medication far outweigh any potential risks.

It is essential for women with ADHD who are thinking of breastfeeding to seek out a specialist psychiatrist's guidance 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 methods. Psychoeducation is also required to help pregnant women suffering from ADHD be aware of the symptoms and the underlying disorder. They should also be educated about treatment options and strengthen coping mechanisms. This should be a multidisciplinary effort with the GPs, obstetricians, and psychiatry. Pregnancy counseling should consist of a discussion of a treatment plan for the mother and child, monitoring of indicators of deterioration, and, if needed modifications to the medication regime.