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ADHD Medication During Pregnancy and Breastfeeding

Women with ADHD must make a difficult decision about whether to continue or stop taking ADHD medication during pregnancy and breast-feeding. There aren't many studies on how long-term exposure may affect a foetus.

A study recently published in Molecular Psychiatry shows that children exposed to ADHD medication during utero do not develop neurological developmental conditions like impaired vision or hearing seizures, febrile seizures, or IQ impairment. The authors acknowledge that more high-quality studies are needed.

Risk/Benefit Analysis

Women who are expecting and taking ADHD medication should weigh the benefits of taking it versus the risks to the foetus. Physicians don't have the information needed to give clear guidelines however they can provide information about risks and benefits that assist pregnant women in making informed choices.

A study published in Molecular Psychiatry found that women who were taking ADHD medications in early pregnancy did not have a significantly increased risk of fetal cardiac malformations or major structural birth defects. Researchers conducted a large sample-based case control study to examine the prevalence of structural defects that were major in infants who were born to mothers who were taking stimulants during pregnancy. Pediatric cardiologists, clinical geneticists and other experts reviewed the cases in order to make sure that the classification was accurate and to reduce any bias.

The study conducted by the researchers was not without its limitations. The researchers were not able in the beginning to distinguish the effects of the medication from the disorder. This limitation makes it difficult to determine whether the small associations observed in the exposed groups are due to medication use or comorbidities that cause confusion. The researchers did not examine the long-term effects for the offspring.

The study did reveal that infants whose mothers took ADHD medication during pregnancy were at a greater risk of being admitted to the neonatal intensive care unit (NICU) than those who whose mothers did not take any medication or had taken off 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 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 one whose baby scored low on the Apgar scale (less than 7). These increases did not appear to be influenced by the kind of medication used during pregnancy.

The research suggests that the low risk associated with the use of ADHD medications during early pregnancy may be offset by the higher benefit for both mother and child from continued treatment for the woman's condition. Physicians should talk to their patients about this and as much as possible, assist them develop coping skills that may reduce the effects of her disorder on her daily functioning and her relationships.

Medication Interactions

As more women than ever are being diagnosed with ADHD and being treated with medication, the issue of whether or not to end treatment during pregnancy is one that more and more physicians face. These decisions are frequently taken without clear and authoritative evidence. Instead, doctors have to consider their own expertise and experience, as well as the experiences of other doctors, and the research on the topic.

The issue of risk for infants can be difficult to determine. Many of the studies on this subject are based on observational evidence rather than controlled research, and their conclusions are often contradictory. Most studies limit their analysis to live births, which can underestimate the teratogenic impact which can cause abortions or terminations of pregnancy. The study discussed in the journal club addresses these issues, by examining both the data from deceased and live births.

Conclusion Some studies have revealed a positive correlation between ADHD medications and certain birth defects, other studies have not shown such a relationship. Most studies show that there is a neutral, or slightly negative, effect. Therefore, a careful risk/benefit analysis must be done in each case.

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 brands uk medication during pregnancy can increase depression, feelings of loneliness, and family conflict for patients with ADHD. A decrease in medication could also affect the ability to drive safely and perform work-related tasks, which are essential aspects of daily life for people with ADHD.

She suggests that women who are unsure whether to continue taking medication or discontinue it due to pregnancy should educate family members, coworkers and friends about the condition, the impact on daily functioning and the benefits of continuing the current treatment regimen. Educating them can also aid in ensuring that the woman feels supported in her struggle with her decision. It is important to remember that certain drugs can be absorbed through the placenta therefore, if a patient decides to stop taking her ADHD medication during pregnancy and breastfeeding, she must be aware of the possibility that traces of the medication for adhd and anxiety in adults could be transferred to the child.

Birth Defects Risk

As the use of ADHD medications to treat symptoms of attention deficit hyperactivity disorder (ADHD) increases as do concerns about what impact the medications could have on fetuses. Recent research published in the journal Molecular Psychiatry has added to the body of knowledge regarding this issue. Utilizing two huge data sets researchers were able to analyze more than 4.3 million pregnancies and determine whether stimulant medication use increased the risk of birth defects. Although the risk overall remains low, the researchers found that exposure in the first trimester to ADHD medicines was associated with a slightly higher rate of certain heart defects like ventriculo-septal defects (VSD).

The researchers of the study found no association between early medication use and other congenital anomalies, like facial clefting, or club foot. The results are in line with previous studies that showed a small, but significant increase in cardiac malformations for women who began taking ADHD medication prior to pregnancy. This risk increased during the latter part of pregnancy, when a lot of women stopped taking their medication.

Women who were taking strattera adhd medication medication in the first trimester were more likely need a caesarean, have a low Apgar after delivery, and had a baby that required help breathing after birth. The authors of the study could not eliminate bias due to selection because they limited their study to women without other medical conditions that could have contributed to the findings.

The researchers hope their research will aid in the clinical decisions of physicians who encounter pregnant women. The researchers recommend that while discussing risks and benefits are important, the decision about whether to continue or stop medication should be according to the severity of each woman's ADHD symptoms and the needs of the woman.

The authors also advise that while discontinuing the medications is an option, it is not a recommended practice because of the high rate of depression and other mental health problems for women who are expecting or recently post-partum. Research has also shown that women who stop taking their medications will have a tough time adjusting to a life without them after the baby is born.

Nursing

It can be a stressful experience to become a mom. Women suffering from ADHD may face a lot of challenges when they must manage their symptoms, go to 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 risk to a breastfeeding infant is not too high since the majority of stimulant medications is absorbed through breast milk in low amounts. However, the amount of medication exposure to the newborn can vary depending on the dosage, frequency it is administered, and the time of the day the medication is administered. Additionally, different medications enter the baby's system differently through the gastrointestinal tract as well as breast milk. The impact of this on a newborn isn't yet fully known.

Due to the absence of research, some doctors may recommend stopping stimulant medication during the course of pregnancy. It is a difficult decision for the woman who must weigh the advantages of taking her medication as well as the potential risks to the foetus. In the meantime, until more information is available, GPs should ask all pregnant patients about their history of ADHD and whether they are taking or planning to take medication during the perinatal period.

A increasing number of studies have shown that the majority of women are able to safely continue their ADHD medication during pregnancy and breastfeeding. In response, a rising number of patients are opting to continue their medication. They have discovered through consultation with their physicians that the benefits of retaining their current medication far outweigh any risk.

It is essential for women with ADHD who are thinking of breastfeeding to seek out a specialist psychiatrist's advice prior becoming pregnant. They should discuss their medication with their prescriber, and the pros and cons for continuing treatment. This includes non-pharmacological methods. Psychoeducation is also required to help pregnant people with ADHD understand their symptoms and the root cause and learn about treatments and to reinforce existing strategies for managing. This should involve an approach that is multidisciplinary, including the GP, obstetricians and psychiatry. Pregnancy counseling should consist of a discussion of a treatment plan for the mother and child, and monitoring for indicators of deterioration, and, if necessary adjustments to the medication regime.