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ADHD Medication During Pregnancy and Breastfeeding

Women suffering from ADHD have to make a difficult choice regarding whether or not to stop taking ADHD medication during pregnancy and breast-feeding. Little data exists about how long-term exposure to these drugs can affect the foetus.

A study recently published in Molecular Psychiatry shows that children exposed to ADHD medication during the uterus do not develop neurological conditions like hearing or vision impairment, febrile seizures, or IQ impairment. The authors acknowledge the need for higher-quality research.

Risk/Benefit Analysis

Pregnant women who take ADHD medications need to balance the benefits of taking them against potential risks to the foetus. Doctors don't have enough data to provide clear recommendations but they can provide information about risks and benefits to assist pregnant women to make informed decisions.

A study published in Molecular Psychiatry found that women who used ADHD medications in early pregnancy did not have an higher risk of fetal cardiac malformations or major birth defects that are structural. Researchers conducted a large sample-based case control study to compare the incidence of major structural defects in infants born to mothers who used stimulants during pregnancy. Pediatric cardiologists, clinical geneticists and other experts reviewed the cases in order to make sure that the classification was correct and to eliminate any bias.

However, the study was not without its flaws. The researchers were unable to, in the first place, to separate the effects caused by the medication from the disorder. This limitation makes it difficult for researchers to establish whether the few associations observed between the groups exposed were due to the use of medications, or if they were affected by the presence of comorbidities. Additionally the researchers did not study the long-term effects of offspring on their parents.

The study revealed that babies whose mothers had taken adhd medication private prescription medication during pregnancy had a higher risk of admission to the neonatal care unit (NICU) as compared to those whose mothers did not take any medication during pregnancy or stopped taking their medication before or during pregnancy. This was due to central nervous system disorders. The higher 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 chance of having caesarean sections or the baby was not scoring well on the Apgar scale (less than 7). These increases appear to be unrelated to the type of medication used during pregnancy.

Researchers suggest that the minor risks posed by the use of ADHD medications in early pregnancies may be offset by the greater benefits for mother and baby from continuing treatment for the woman's disorder. Doctors should discuss with their patients about this issue and as much as possible, assist them improve coping skills which can lessen the impact of her disorder in her daily life and relationships.

Medication Interactions

Doctors are increasingly faced with the decision of whether to continue treatment or stop as more women are diagnosed with ADHD. The majority of these decisions are taken in the absence of any evidence that is clear and definitive in either case, which means that doctors must weigh what they know from their own experiences, those of other doctors, and what research says on the topic as well as their own judgments for each individual patient.

Particularly, the subject of potential risks for the baby can be tricky. The research on this subject is based on observations rather than controlled studies and many of the findings are conflicting. The majority of studies focus on live-births, which could underestimate the teratogenic impact that can lead to terminations or abortions of pregnancy. The study discussed in the journal club addresses these shortcomings by analyzing both data on live and deceased births.

Conclusion: While some studies have shown a positive correlation 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, impact. In every case it is imperative to conduct a thorough evaluation of the benefits and risks must be performed.

For women suffering from ADHD, the decision to discontinue medication can you get adhd medication without a diagnosis be difficult, if not impossible. In an article published in the Archives of Women's Mental Health, psychologist Jennifer Russell notes that stopping ADHD medication during pregnancy can lead to increased depression, feelings of isolation, and family conflict for those suffering from the disorder. A decrease in medication could also affect the ability to drive safely and perform work-related tasks, which are vital aspects of everyday life for those suffering from ADHD.

She suggests women who are unsure about whether to continue or stop taking medication because of their pregnancy consider the possibility of educating friends, family members and colleagues about the condition, its effects on daily functioning, and on the advantages of staying on the current treatment regimen. In addition, educating them can aid in ensuring that the woman feels supported as she struggles with her decision. It is also worth noting that certain medications can pass through the placenta so if a woman decides to stop taking her ADHD medication during pregnancy and breastfeeding, she should be aware that traces of the drug could be transferred to the child.

Risk of Birth Defects

As the use of ADHD medications to treat symptoms of attention deficit hyperactivity disorder (adhd medication making it worse) grows, so do concerns about what impact the medications could have on foetuses. Recent research published in the journal Molecular Psychiatry has added to the body of knowledge regarding this subject. Researchers used two massive datasets to analyze over 4.3 million pregnancy and determine whether stimulant medications increased the risk of birth defects. While the overall risk is low, the researchers found that exposure in the first trimester to ADHD medications was associated with an increased risk of certain heart defects, such as ventriculo-septal defect (VSD).

The researchers of the study could not discover any link between the use of early medications used for adhd (mitchell-boyd-3.technetbloggers.de`s latest blog post) and congenital anomalies like facial deformities, or club feet. The findings are in line with previous studies revealing a small but significant increase in the risk of developing cardiac malformations in women who started taking ADHD medications before the time of pregnancy. The risk increased in the latter half of pregnancy, when a lot of women began to stop taking their medication.

Women who took ADHD medication in the first trimester were more likely require a caesarean birth and also have an insufficient Apgar after birth and had a baby that required help breathing after birth. However the authors of the study were not able to eliminate selection bias by limiting the study to women who did not have any other medical issues that could have contributed to the findings.

Researchers hope their research will inform physicians when they meet pregnant women. The researchers recommend that while discussing the risks and benefits are important, the decision on whether to continue or stop medication should be according to the severity of each woman's ADHD symptoms and her needs.

The authors warn that, even though stopping the medication is an option to think about, it isn't recommended because of the high incidence of depression and other mental disorders for women who are pregnant or have recently given birth. Further, research shows that women who stop taking their medication will have a difficult time adjusting to a life without them once the baby is born.

Nursing

The responsibilities of being a new mother can be overwhelming. Women suffering from ADHD can face severe challenges when they must deal with their symptoms, attend doctor appointments, prepare for the birth of a baby and adjust to new routines. Many women opt to continue taking their ADHD medication during pregnancy.

The risk for nursing infant is low because the majority of stimulant medications passes through breast milk at low levels. However, the amount of exposure to medications by the infant can differ based on the dosage, frequency it is taken and at what time the medication is administered. In addition, various medications enter the baby’s system through the gastrointestinal tract or through breast milk. The impact on the health of a newborn isn't fully understood.

Some doctors may stop taking stimulant medication during a woman's pregnancy due to the absence of research. This is a difficult choice for the patient, who must weigh the benefits of continuing her medication with the potential dangers to the foetus. In the meantime, until more information is available, doctors should inquire with all pregnant patients about their experience with ADHD and if they plan or are taking to take medication during the perinatal time.

A growing number of studies have proven that most women can safely continue taking their ADHD medication while they are pregnant and nursing. In response, a growing number of patients are opting to do this. They have concluded, in consultation with their doctor, that the benefits of retaining their current medication far outweigh any risk.

Women with ADHD who plan to breastfeed should seek the advice of a specialist psychiatrist before becoming pregnant. They should review their medications with their doctor and discuss the advantages and disadvantages of continued treatment, including non-pharmacological strategies. Psychoeducation should also be provided to help women with ADHD recognize their symptoms and the underlying disorder and learn about treatment options and reinforce existing strategies for managing. This should be a multidisciplinary effort including obstetricians, GPs and psychiatry. Pregnancy counseling should consist of 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.