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ADHD Medication During Pregnancy and Breastfeeding

The decision to stop or continue ADHD medication 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 fetus.

A study recently published in Molecular Psychiatry shows that children exposed to ADHD medication during the uterus don't develop neurological developmental conditions like impaired vision or hearing, febrile seizures, or IQ impairment. The authors acknowledge that more high-quality studies are required.

Risk/Benefit Analysis

Women who are pregnant and take ADHD medication should evaluate the benefits of using it against the possible risks for the fetus. Doctors don't have enough data to provide clear recommendations however they can provide information on risks and benefits to aid pregnant women in making informed choices.

A study published in Molecular Psychiatry concluded that women who were taking ADHD medication during early pregnancy were not at a greater risk of fetal malformations, or structural birth defects. Researchers conducted a massive sample-based case control study to compare the incidence of structural defects that were major in infants who were born to mothers who took stimulants during pregnancy. Pediatric cardiologists, clinical geneticists and other experts reviewed the cases in order to confirm that the classification was correct and to reduce any bias.

However, the study had its limitations. Researchers were unable in the beginning, to separate the effects caused by the medication from the disorder. This makes it difficult to know whether the small associations observed in the groups that were exposed are due to the use of medication or the confounding effect of comorbidities. In addition the researchers did not examine the long-term outcomes of offspring.

The study did find that infants whose mothers took strongest adhd medication medication during pregnancy were at slightly greater risk of being admitted to the neonatal intensive care unit (NICU) than those who were born without any medication or had cut back on their medications prior to or during pregnancy. This was due to central nervous system-related disorders and the increased risk for admission was not found to be influenced by which stimulant medications were taken during pregnancy.

Women who used stimulant ADHD medication during pregnancy also had an elevated chance of having a caesarean section or having a baby with a low Apgar score (less than 7). These increases didn't appear to be influenced by the kind of medication used during pregnancy.

Researchers suggest that the small risk of using ADHD medications during early pregnancies could be offset by the more beneficial outcomes for both mother and baby from continuing treatment for the woman's disorder. Physicians should discuss this with their patients and, when they are able, assist them in developing strategies for improving their coping skills that may minimize the impact of her disorder on her daily life and relationships.

Interactions with Medication

More and more doctors are confronted with the dilemma of whether to maintain treatment or stop during pregnancy as more women are diagnosed with ADHD. These decisions are usually taken without clear and authoritative evidence. Instead, doctors have to consider their own expertise in conjunction with the experiences of other doctors, and the research on the topic.

Particularly, the issue of potential risks to the baby can be a challenge. The research that has been conducted on this topic is based on observation rather than controlled studies, and the results are in conflict. Additionally, the majority of studies limit their analysis to live births, which may underestimate the severity of teratogenic effects that could lead to abortion or termination of the pregnancy. The study discussed in this journal club addresses these issues by looking at data from both live and deceased births.

Conclusion Some studies have revealed an association between ADHD medications and certain birth defects However, other studies haven't found a correlation. The majority of studies show an unintended, or slightly negative, effect. Therefore, a careful risk/benefit assessment must be conducted in every case.

It can be difficult, if not impossible, for women with ADHD to stop taking their medication. In a recent article in the Archives of Women's Mental Health psychologist Jennifer Russell notes that stopping ADHD medication during pregnancy can increase depression, feelings of loneliness, and family conflict for those suffering from the disorder. Additionally, the loss of medication can interfere with the ability to complete job-related tasks and drive safely that are crucial aspects of a normal life for a lot of people with ADHD.

She suggests that women who are unsure whether to continue taking medication or discontinue it due to pregnancy educate family members, coworkers, and acquaintances about the condition, the impact on daily functioning and the benefits of continuing the current treatment regimen. It will also help a woman feel confident about her decision. Certain medications can pass through the placenta. If a woman decides not to take her ADHD medication while breastfeeding, it is important to be aware that the drug could be passed on to her baby.

Risk of Birth Defects

As the use of ADHD medication to treat the symptoms of attention deficit hyperactivity disorder (ADHD) increases as do concerns over the impact that these drugs might have on fetuses. A study that was published in the journal Molecular Psychiatry adds to the existing knowledge about this subject. With two massive data sets researchers were able look at more than 4.3 million pregnancies and determine whether the use of stimulant medications increased the risk of birth defects. Although the risk overall remains low, the researchers discovered that the first-trimester exposure to ADHD medications was linked to an increased risk of certain heart defects like ventriculo-septal defects (VSD).

The researchers of the study found no link between the use of early medications and other congenital abnormalities, like facial clefting, or club foot. The findings are in line with previous studies revealing a small but significant increase in the risk of heart malformations in women who started taking ADHD medications prior to the time of the time of pregnancy. The risk was higher in the later part of pregnancy, when a lot of women decide to stop taking their ADHD medications.

Women who took ADHD medication during the first trimester were more likely to require a caesarean birth or have an insufficient Apgar after delivery, and had a baby that required breathing assistance after birth. However the authors of the study were not able to eliminate bias due to selection by limiting the study to women who didn't have any other medical issues that could have contributed to these findings.

Researchers hope that their study will inform physicians when they see pregnant women. The researchers advise that, while discussing risks and benefits are important, the decision about whether to continue or stop medication should be in light of the severity of each woman's ADHD symptoms and the needs of the woman.

The authors caution that, although stopping the medication is a possibility to look into, it is not recommended due to the high prevalence of depression and mental health issues in women who are expecting or recently gave birth. Further, the research suggests that women who choose to stop taking their medication are more likely to have difficulties getting used to life without them following the birth of their baby.

Nursing

The responsibilities of a new mom can be overwhelming. Women with ADHD who have to manage their symptoms while attending physician appointments, making preparations for the arrival of a child and adjusting to new household routines may face a lot of challenges. Many women opt to continue taking their ADHD medication during pregnancy.

human-givens-institute-logo.pngThe risk to a breastfeeding infant is minimal because the majority of stimulant medication passes through breast milk at a low level. The rate of medication exposure will vary based on the dosage and frequency of administration as well as time of day. Additionally, different medications enter the baby’s system via the gastrointestinal tract or through breast milk. The effect on a newborn's health is not fully understood.

Some doctors may decide to stop stimulant medication during a woman’s pregnancy due to the lack of research. This is a difficult decision for the patient, who must balance the benefit of continuing her medication with the potential risks to the embryo. Until more information becomes available, doctors may inquire about pregnant patients whether they have a background of ADHD or if they intend to take medication during the perinatal period.

Numerous studies have demonstrated that women can continue taking their ADHD medication in a safe manner during pregnancy and breast-feeding. In the end, many patients are choosing to do so and after consulting with their doctor, they have discovered that the benefits types Of adhd medication continuing their current medication far outweigh any potential risks.

It is crucial for women suffering from best adhd medication for adults with anxiety and depression who are considering breastfeeding to seek out a specialist psychiatrist's advice prior becoming pregnant. They should discuss their medication with their prescriber and discuss the pros and cons of continued treatment, including non medication treatment for adhd adults-pharmacological strategies. Psychoeducation should also be offered to help pregnant women suffering from ADHD recognize their symptoms and underlying disorder, learn about available treatment options and strengthen existing strategies for managing. This should be a multidisciplinary approach with the GP doctors, obstetricians and psychiatrists. Pregnancy counseling should include a discussion of a treatment plan for the mother and the child, monitoring of signs of deterioration and, if needed modifications to the medication regime.

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