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ADHD Medication During Pregnancy and Breastfeeding

The choice of whether to stop or continue ADHD medications during pregnancy and breastfeeding is a difficult decision for women suffering from the condition. There isn't much information on how long-term exposure to these drugs may affect the foetus.

A study recently published in Molecular Psychiatry demonstrates that children exposed to ADHD medication during pregnancy do not develop neurological disorders such as hearing loss or vision, febrile seizures or IQ impairment. The authors acknowledge that further high-quality studies are required.

Risk/Benefit Analysis

Women who are pregnant and taking ADHD medication need to weigh the benefits of taking it against the potential risks for the foetus. The doctors don't have the information to make unambiguous recommendations, but 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 were taking Adhd Medication Pregnancy medications during their early pregnancy did not face a significantly increased risk of fetal heart malformations or major structural birth defects. The researchers used a large, population-based case-control study to assess the risk of major structural birth defects in infants born to mothers who took stimulants during early pregnancy, and those who did not. Clinical geneticists and pediatric cardiologists reviewed the cases to ensure an accurate case classification and to limit the possibility of bias.

However, the study had its limitations. Researchers were unable to, in the first place to differentiate the effects of the medication from the disorder. This makes it difficult to determine whether the small differences observed in the groups that were exposed are due to the use of medication or confounding by comorbidities. The researchers did not study long-term outcomes for offspring.

The study did show that infants whose mothers had taken ADHD medications during pregnancy were at slightly greater risk of being admitted to the neonatal intensive care unit (NICU) than those whose mothers had not taken any medication or stopped their medications before or during pregnancy. This increase was due to central nervous system-related disorders, and the higher risk of admission did not appear to be influenced by the stimulant medication was used during pregnancy.

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

The research suggests that the low risk associated with the use of ADHD medications during the early stages of pregnancy could be offset by the greater benefit to both mother and child from continued treatment for the woman's disorder. Physicians should discuss the issue with their patients and, when they are able, assist them in developing strategies to improve coping skills that may minimize the impact of her disorder on her daily life and relationships.

Medication Interactions

More and more doctors are faced with the decision of whether to continue treatment or stop as more women are diagnosed with ADHD. The majority of these decisions are made in the absence of solid and reliable evidence regardless, so doctors must weigh what they know from their own experiences, those of other doctors, and what research suggests on the subject as well as their own best judgment for each individual patient.

The issue of risk to infants is particularly tricky. A lot of studies on this subject are based on observational evidence rather than controlled research and their conclusions are often contradictory. The majority of studies limit their analysis to live-births, which could underestimate the teratogenic impact leading to abortions or terminations of 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 found an association between ADHD medications and certain birth defects However, other studies haven't found a correlation. Most studies have shown a neutral, or even slightly negative, impact. In all cases an in-depth study of the potential risks and benefits is required.

It can be difficult, if not impossible for women with ADHD to stop taking their medication. In fact, in a recent article in Archives of Women's Mental Health, psychologist Jennifer Russell notes that stopping ADHD medication during pregnancy can cause depression, feelings of loneliness and family conflict for these patients. The loss of medication can also impact the ability to drive safely and perform work-related tasks, which are essential aspects of everyday life for people with ADHD.

She suggests that women who are unsure whether to continue taking medication or stop due to pregnancy educate family members, coworkers and their friends about the condition, its impact on daily functioning and the benefits of continuing the current treatment. Educating them can also help the woman feel supported in her struggle with her decision. Certain medications can pass through the placenta. If a woman decides to stop taking her ADHD medication while pregnant and breastfeeding, it is crucial to be aware that the drug could be transferred to the baby.

Risk of Birth Defects

As the use of ADHD drugs to treat symptoms of attention deficit hyperactivity disorder (ADHD) grows as do concerns over the impact that these drugs could have on the fetuses. Recent research published in the journal Molecular Psychiatry has added to the body of knowledge on this topic. Utilizing two huge data sets researchers were able to look at more than 4.3 million pregnancies and see whether stimulant medication use increased the risk of birth defects. While the overall risk remains low, the scientists did find that first-trimester exposure to ADHD medications was linked to an increase in the risk of certain heart defects like ventriculo-septal defects (VSD).

The researchers of the study found no link between early medication use and other congenital abnormalities, such as facial clefting or club foot. The results are in agreement with previous studies that have shown a small, but significant increase in the number of cardiac malformations among women who started taking ADHD medication before pregnancy. This risk increased in the later part of pregnancy, when a lot of women are forced to stop taking their medication.

Women who took ADHD medication in the first trimester were more likely to require a caesarean birth and also have a low Apgar after delivery and had a baby that required help breathing at birth. The authors of the study were not able to eliminate selection bias because they limited their study to women with no other medical conditions that could have contributed to the findings.

Researchers hope that their study will inform physicians when they see pregnant women. The researchers recommend that while discussing the risks and benefits are important, the choice 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 even though stopping the medication is an option, it isn't an option that is recommended due to the high prevalence of depression and other mental health problems for women who are expecting or who are recently post-partum. Additionally, the research suggests that women who choose to stop their medications are more likely to have difficulties adjusting to life without them after the birth of their baby.

Nursing

It can be overwhelming 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 a child and adjust to a new routine. As such, many women decide to continue taking their ADHD medications throughout the course of pregnancy.

The majority of stimulant medications pass through breast milk in low quantities, so the risk to the breastfeeding infant is minimal. However, the frequency of exposure to medication by the newborn may differ based on dosage, how often it is taken and at what time it is administered. Additionally, different types of adhd medication drugs enter the infant's system via the gastrointestinal tract or breast milk. The impact of these medications on the health of a newborn isn't completely comprehended.

Due to the absence of evidence, some doctors may be inclined to discontinue stimulant drugs during the pregnancy of a woman. This is a difficult decision for the woman, who must weigh the advantages of her medication against the potential risks to the embryo. Until more information is available, GPs should ask all pregnant patients about their history of ADHD and if they plan or are taking to take medication during the perinatal period.

A growing number of studies have shown that women can continue to take their ADHD medication while they are pregnant and nursing. In the end, an increasing number of patients are choosing to do so and after consulting with their doctor, they have found that the benefits of continuing their current medication far exceed any risk.

Women who suffer from ADHD who plan to breastfeed should seek advice from a specialist psychiatrist before becoming pregnant. They should discuss their medication with their physician and discuss the advantages and disadvantages of continuing treatment, including non-pharmacological management strategies. Psychoeducation is also required to help pregnant women suffering from ADHD be aware of their symptoms and underlying disorder, learn about available treatments and to reinforce existing coping strategies. This should include 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 treatment plan for both the mother and child, and monitoring for signs of deterioration, and when necessary, making adjustments to the medication regimen.