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https://www.iampsychiatry.uk/adult-adhd-medication/
ADHD Medication During Pregnancy and Breastfeeding The choice of whether to stop or continue ADHD medication during breastfeeding and pregnancy is a difficult decision for women suffering from the condition There are few data regarding how exposure over time may affect a foetus A study recently published in Molecular Psychiatry shows that children exposed to ADHD medication in the uterus do not develop neurological disorders like impaired vision or hearing febrile seizures or IQ impairment The authors acknowledge the need for more highquality studies RiskBenefit Analysis Pregnant women who take ADHD medications must weigh the advantages of taking them against the potential risks to the fetus Doctors dont have the data needed to give clear guidelines however they can provide information on risks and benefits that help pregnant women make informed decisions A study published in Molecular Psychiatry concluded that women who took ADHD medication during early pregnancy were not at higher risk of fetal malformations or structural birth defects Researchers conducted a massive populationbased study of case control to compare the incidence of major structural defects in infants who were born to mothers who used stimulants during pregnancy Clinical geneticists and pediatric cardiologists reviewed the cases to ensure an accurate case classification and to minimize the possibility of bias The study of the researchers had some limitations The researchers were unable to in the first place to separate the effects triggered by the medication from the disorder This makes it difficult to determine whether the small differences observed in the groups that were exposed result from medication use or the confounding effect of comorbidities In addition the researchers did not study the longterm outcomes of offspring The study did reveal that babies whose mothers had taken ADHD medication during pregnancy were at a slightly higher risk of being admitted to the neonatal intensive care unit NICU than infants who whose mothers did not take any medication or stopped their medications before or during pregnancy This increase was due to central nervous systemrelated disorders and the increased risk for admission did not appear to be affected by the type of stimulant medications were used during pregnancy Women who took stimulant ADHD medications during pregnancy also had a higher risk of having to have a caesarean section or a baby that scored low on the Apgar scale less than 7 These increases did appear to be independent of the type of medication taken during pregnancy Researchers suggest that the minor risk of using ADHD medications during early pregnancies could be offset by the greater benefits to both baby and mother of continued treatment for the womans condition Physicians should talk to their patients about this issue and try to help them improve coping skills which may reduce the impact of her disorder in her daily life and relationships Interactions with Medication As more women than ever are being diagnosed with ADHD and being treated with medication the dilemma of whether or not to stop treatment during pregnancy is one that more and more doctors have to face The majority of these decisions are made without clear and authoritative evidence regardless so doctors have to weigh their experience the experiences of other doctors and what the research suggests on the subject as well as their own judgments for each individual patient In particular the issue of possible risks to the baby can be a challenge Many of the studies on this issue are based on observational evidence rather than controlled research and their findings are often contradictory Furthermore most studies restrict their analysis to live births which may underestimate the severity of teratogenic effects that could cause abortion or termination of the pregnancy iampsychiatry discussed in this journal club addresses these shortcomings by examining data on both live and deceased births Conclusion A few studies have shown an association between ADHD medications and certain birth defects however other studies havent found a correlation The majority of studies show that there is a neutral or somewhat negative impact In the end a careful riskbenefit assessment is required in every case For a lot of women with ADHD the decision to stop medication can be difficult if not impossible In fact in an article published in Archives of Womens Mental Health psychologist Jennifer Russell notes that stopping ADHD medication during pregnancy can cause depression feelings of isolation and family conflict for those suffering from the disorder In addition a decrease in medication can affect the ability to perform jobrelated tasks and drive safely which are important aspects of daily life for a lot of people with ADHD She suggests women who are unsure about whether to keep or stop taking medication because of their pregnancy should consider the possibility of educating friends family members and coworkers on the condition its effects on daily functioning and on the advantages of staying on the current treatment regimen Educating them can also aid in ensuring that the woman feels supported when she is struggling with her decision Certain medications can pass through the placenta If a patient decides to stop taking her ADHD medication while pregnant and breastfeeding it is crucial to be aware that the medication could be transferred to the baby Birth Defects Risk As the use and misuse of ADHD drugs to treat symptoms of attention deficit disorder hyperactivity disorder ADHD increases so does concern about the potential adverse effects of the drugs on fetuses Recent research published in the journal Molecular Psychiatry has added to the body knowledge on this issue Using two massive data sets researchers were able to look at more than 43 million pregnancies to determine whether stimulant medication use increased the risk of birth defects Researchers discovered that while the risk overall is low the first trimester ADHD medication exposure was associated with slightly higher rates of certain heart defects such as ventriculoseptal defect The researchers of the study didnt discover any link between early medication usage and other congenital anomalies such as facial deformities or club feet The results are in agreement with previous studies that showed an insignificant but small increase in cardiac malformations for women who started taking ADHD medication before pregnancy The risk was higher in the latter half of pregnancy when many women begin to discontinue their ADHD medications Women who took ADHD medication in the first trimester were more likely to require a caesarean birth or have a low Apgar after birth and have a baby that needed breathing assistance after birth The researchers of the study were not able to eliminate bias due to selection because they limited the study to women who did not have any other medical conditions that could have contributed to the findings Researchers hope their research will inform physicians when they encounter pregnant women The researchers suggest that while discussing risks and benefits are crucial the decision about whether to continue or stop taking medication should be in light of the severity of each womans ADHD symptoms and her requirements The authors warn that while stopping the medication is a possibility to look into it is not recommended because of the high incidence of depression and mental health issues among women who are pregnant or recently gave birth Additionally research suggests that women who stop taking their medications will have a difficult adjustment to life without them once the baby is born Nursing The responsibilities that come with being a new mom can be overwhelming Women with ADHD who have to deal with their symptoms while attending doctor appointments and making preparations for the arrival of their child and getting used to new routines at home may face a lot of challenges Therefore many women decide to continue taking their ADHD medication throughout the pregnancy The majority of stimulant drugs are absorbed by breast milk in small amounts therefore the risk for nursing infant is very low However the amount of exposure to medication by the newborn may differ based on dosage frequency it is administered and the time of day the medication is administered In addition various medications enter the babys system through the gastrointestinal tract or through breast milk The impact of these medications on a newborns health is not fully comprehended Some doctors may stop taking stimulant medication during a womans pregnancy due to the lack of research Its a difficult choice for the mother who must weigh the benefits of taking her medication as well as the potential risks to the embryo Until more information is available GPs should ask all pregnant patients about their experience with ADHD and if they are planning or taking to take medication during the perinatal time Many studies have shown that women can continue to take their ADHD medication safely during pregnancy and while breastfeeding In the end an increasing number of patients choose to do so and in consultation with their doctor they have discovered that the benefits of keeping their current medication far exceed any risk It is crucial for women suffering from ADHD who are considering breastfeeding to seek a specialist psychiatrists advice prior becoming pregnant They should discuss their medication with their prescriber and discuss the pros and cons for continuing treatment This includes nonpharmacological strategies Psychoeducation should also be provided to help women with ADHD recognize their symptoms and the underlying disorder learn about available treatment options and reinforce existing strategies for managing 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 signs of deterioration and if needed adjustments to the medication regimen
