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ADHD Medication During Pregnancy and Breastfeeding The choice of whether to stop or continue ADHD medication during pregnancy and breastfeeding is challenging for women with the condition. There aren't enough data on how long-term exposure may affect the foetus. A recent study 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 further high-quality studies are required. Risk/Benefit Analysis Women who are pregnant and taking ADHD medication need to consider the benefits of taking it against the potential risks to the foetus. Doctors don't have the data needed to give clear guidelines however they can provide information about the risks and benefits to aid pregnant women in making informed choices. A study published in Molecular Psychiatry found that women who used ADHD medications in early pregnancy did not face a significantly higher risk of fetal cardiac malformations or major structural birth defects. Researchers conducted a large population-based case-control study to assess the risk of major structural birth defects in babies born to mothers who took stimulants during early pregnancy and those who had not. Pediatric cardiologists, clinical geneticists and other experts looked over the cases to ensure that the classification was accurate and to reduce any bias. However, the researchers' study was not without its flaws. The researchers were not able, in the first place, to separate the effects of the medication from the disorder. This limitation makes it difficult to determine whether the limited associations observed in the groups that were exposed are due to medication use or the confounding effect of comorbidities. Additionally, the researchers did not look at the long-term effects of offspring on their parents. The study found that infants whose mothers took ADHD medication during pregnancy had a slightly higher chance of being admitted to the neonatal care unit (NICU) as compared to those whose mothers did not take any medication during pregnancy, or had quit taking the medication prior to or during pregnancy. This increase was caused by central nervous system disorders. The higher risk of admission was not influenced by the stimulant medication that was used during pregnancy. Women who used stimulant ADHD medication during pregnancy also had an elevated chance of having a caesarean delivery or having a baby with an low Apgar score (less than 7). These risks did not seem to be influenced by the kind of medication used during pregnancy. Researchers suggest that the small risks posed by the use of ADHD medication during pregnancies in the early stages can be offset by greater benefits for baby and mother of continued treatment for the woman's condition. Physicians should talk to their patients about this issue and as much as possible, assist them develop coping skills that could reduce the impact of her disorder in her daily life and relationships. Medication Interactions Many doctors are confronted with the dilemma of whether to maintain treatment or stop it during pregnancy as more women are diagnosed with ADHD. Most of the time, these decisions are made in the absence of solid and reliable evidence regardless, so doctors have to weigh their experience from their own experiences, those of other doctors, and what the research suggests on the subject and their own judgments for each patient. Particularly, the subject of potential risks for the infant can be difficult. The research on this subject is based on observations rather than controlled studies, and many of the findings are contradictory. The majority of studies focus on live births, which can underestimate the teratogenic impact which can cause abortions or terminations of pregnancy. The study that is discussed in the journal club addresses these issues by analyzing both information on deceased and live births. Conclusion: While some studies have found an association between ADHD medications and certain birth defects however, other studies haven't shown such a relationship. The majority of studies show that there is a neutral, or somewhat negative, impact. In every case an in-depth study of the risks and benefits should be conducted. For many women with ADHD and ADD, the decision to stop taking medication is difficult, if not impossible. In a recent article in Archives of Women's Mental Health by psychologist Jennifer Russell, she notes that stopping ADHD medications during pregnancy can lead to depression and feelings of being isolated. Additionally, the loss of medication can affect the ability to perform work-related tasks and safely drive which are essential aspects of a normal life for many people suffering from ADHD. She suggests that women who are not sure whether to take the medication or discontinue it due to pregnancy, educate their family members, coworkers, and acquaintances about the condition, the effects on daily functioning, and the benefits of continuing the current treatment plan. It can also help a woman feel more confident in her decision. It is important to remember that certain medications are able to pass through the placenta therefore, if a patient decides to discontinue her ADHD medication during pregnancy and breastfeeding, she must be aware of the possibility that traces of the drug could be transferred to the infant. Birth Defects and Risk of As the use of ADHD medication to treat the symptoms of attention deficit hyperactivity disorder (ADHD) increases as do concerns about the effects that the medications could have on the 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 study over 4.3 million pregnancy and determine if the use of stimulant medications increased the risk of 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 specific heart defects like ventriculoseptal defects. The authors of the study found no association between early medication use and other congenital abnormalities, like facial clefting, or club foot. The results are in line with previous studies that have shown the existence of a slight, but significant increase in cardiac malformations for women who began taking ADHD medication prior to the time of the time of pregnancy. This risk increased in the later part of pregnancy, when a lot of women decide to stop taking their ADHD medications. Women who took ADHD medications in the first trimester of pregnancy were also more likely to experience caesarean sections, a low Apgar score after delivery and a baby who needed breathing assistance during 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 conditions that could be a contributing factor to these findings. Researchers hope that their study will inform physicians when they meet pregnant women. They suggest that although discussing the risks and benefits is crucial, the decision to stop or maintain treatment must be based on each woman's requirements and the severity of her ADHD symptoms. The authors also advise that, while stopping the medication is an option, it is not a recommended practice because of the high incidence of depression and other mental health problems among women who are pregnant or who are recently post-partum. Further, research shows that women who stop taking their medications will have a difficult time adjusting to a life without them after the baby is born. Nursing It can be overwhelming becoming a mother. Women who suffer from ADHD may face a lot of challenges when they have to manage their symptoms, go to doctor appointments and prepare for the birth of a baby and adjust to a new routine. Therefore, many women elect to continue taking their ADHD medications throughout pregnancy. The risk to a breastfeeding infant is minimal because the majority of stimulant medications passes through breast milk at a low level. However, the frequency of medication exposure to the infant can differ based on 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 and the impact of this on a newborn is not well understood. Some doctors may stop taking stimulant medication during a woman's pregnancy due to the lack of research. This is a complicated decision for the patient, who must balance the benefit of continuing her medication with the potential risks to the embryo. As long as there is no more information, doctors should inquire with all pregnant patients about their experience with ADHD and if they are planning or taking 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 while breastfeeding. In response, a rising number of patients are choosing to continue their medication. add medication adults have concluded after consulting with their doctor that the benefits of retaining their current medication outweigh risk. Women who suffer from ADHD who are planning to nurse should seek the advice of an expert psychiatrist prior to becoming pregnant. They should discuss their medication with their doctor and discuss the pros and cons for continuing treatment. This includes non-pharmacological strategies. Psychoeducation is also required to help pregnant women with ADHD be aware of the symptoms and underlying disorder. They should also be educated about treatment options and reinforce strategies for coping. This should be a multidisciplinary process including obstetricians, GPs and psychiatrists. Counselling for pregnancy should include the discussion of a treatment plan for both mother and child, and monitoring for signs of deterioration, and, if necessary, adjustments to the medication regimen.